Menorrhagia is a common clinical problem among reproductive age women and 5% of women in the US seek medical attention annually for menorrhagia. Recent studies suggest that underlying bleeding disorders, particularly Von Willebrand disease and platelet dysfunction, are prevalent in women presenting with menorrhagia. However referral for comprehensive hemostatic evaluation of the substantial numbers of women with otherwise unexplained menorrhagia is problematic given the complexity, availability, and cost of hemostatic testing and the lack of effective point of care screening tests for this population. In the present study, we evaluated 146 women (ages 13–55 yrs) with unexplained menorrhagia in order to develop a simple screening tool for stratifying women for referral for comprehensive hemostatic evaluation and testing. Women with a physician diagnosis of menorrhagia were studied on days 3–9 of their menstrual cycle. ASA, NSAIDS, herbals and other potentially platelet function impairing medications were discontinued at least 14 days prior to study and estrogen based treatment was discontinued for at least 1 menstrual cycle. Women underwent comprehensive hemostatic testing including VWF, platelet aggregation and ATP release, and factor assays. A 12 page questionnaire was developed based on significant bleeding symptoms in a CDC study of women with known VWD (

Drews CD, Dilley AB, Lally C, Beckman MG, Evatt B. J Am Med Womens Assoc 2002;57:217–218
) and was administered to study subjects. A combination of 8 questions in 4 categories, including history of duration/extent of menorrhagia, anemia treatment, excessive bleeding with hemostatic challenges, and family diagnosis, resulted in a sensitivity of 81% (95% CI 74–89) and positive predictive value 71% (95% CI 63–71) for hemostatic abnormalities. Adding a pictorial blood assessment chart score > 100 increased the sensitivity of the screening tool to 93% (95% CI 89–98). The data suggest that a simple 8 question screening tool with implementation of a pictorial blood assessment chart may be useful for physicians evaluating women presenting with menorrhagia to help determine which women to refer for comprehensive hemostastic testing and evaluation.

Topics:
menorrhagia, screening, hemostatics, hemorrhage, anemia, anti-inflammatory agents, non-steroidal, bleeding diathesis, blood coagulation disorders, blood platelet disorders, estrogen

Disclosure: No relevant conflicts of interest to declare.

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2006, The American Society of Hematology
2006
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