Abnormal bleeding patterns associated with menorrhagia in women in the community and in women presenting to primary care.

BACKGROUND: There is an assumption that in women with menorrhagia 'excessive menstrual loss in regular cycles is the most common clinical presentation' yet epidemiological studies show irregular cycles and bleeding are common.
OBJECTIVES: To test the hypothesis that, in women who present to primary care with menorrhagia, excessive menstrual loss in regular cycles is the most common clinical presentation, and to determine the frequency with which symptoms known to be associated with gynaecological malignancy occur.
METHODS: A postal survey of all women aged 18-54 years was used to identify symptoms of vaginal bleeding in an urban general practice with 10 000 registered patients. Follow-up surveys were carried out at 6 and 12 months. Consultation data from general practice held records were gathered from baseline to 18 months. Women who consulted with increased vaginal bleeding during the 18-month study period were separately analysed according to their self-reported symptoms in the questionnaire completed in the 6 months prior to the consultation.
RESULTS: At baseline, of the 736 women in the community identified with menorrhagia, 46% had at least one symptom of irregular vaginal bleeding. In the subgroup of 138 women with menorrhagia who consulted primary care with increased vaginal bleeding, the proportion with at least one symptom of irregular vaginal bleeding was 73%.
CONCLUSION: In women with heavy menstrual bleeding, excessive menstrual loss in regular cycles is not the most common clinical presentation in primary care. Guidelines on menorrhagia should acknowledge the variety of symptoms that women with heavy menstrual bleeding present to primary care.