Signs and symptoms that suggest an underlying bleeding disorder
| With the acceptance that menorrhagia is generally defined as >80 mL of blood loss per menstrual cycle, the following associations were agreed on as being indicative of menorrhagia |
| Soaking through a pad or tampon within 1 h |
| Soaking through bedclothes |
| Below normal ferritin |
| Anemia |
| Pictorial blood assessment chart score >100 |
| An underlying bleeding disorder should be considered if any of the following are present: |
| Menorrhagia since menarche |
| Family history of a bleeding disorder |
| Personal history of 1, but usually several, of the following symptoms: |
| Epistaxis (generally bilateral epistaxis, >10 min duration, once in the last year possibly necessitating packing or cautery) |
| Notable bruising without injury (and >2 cm in diameter) |
| Minor wound bleeding (ie, from trivial cuts lasting for >5 min) |
| Bleeding of oral cavity or gastrointestinal tract without an obvious anatomic lesion |
| Prolonged or excessive bleeding after dental extraction |
| Unexpected postsurgical bleeding |
| Hemorrhage from ovarian cysts or corpus luteum, possibly with accompanying pain during ovulation (termed mittleschmerz) |
| Hemorrhage that required blood transfusion |
| Postpartum hemorrhage (PPH), especially delayed PPH (after 24 h; no response to conventional management of menorrhagia) |
| With the acceptance that menorrhagia is generally defined as >80 mL of blood loss per menstrual cycle, the following associations were agreed on as being indicative of menorrhagia |
| Soaking through a pad or tampon within 1 h |
| Soaking through bedclothes |
| Below normal ferritin |
| Anemia |
| Pictorial blood assessment chart score >100 |
| An underlying bleeding disorder should be considered if any of the following are present: |
| Menorrhagia since menarche |
| Family history of a bleeding disorder |
| Personal history of 1, but usually several, of the following symptoms: |
| Epistaxis (generally bilateral epistaxis, >10 min duration, once in the last year possibly necessitating packing or cautery) |
| Notable bruising without injury (and >2 cm in diameter) |
| Minor wound bleeding (ie, from trivial cuts lasting for >5 min) |
| Bleeding of oral cavity or gastrointestinal tract without an obvious anatomic lesion |
| Prolonged or excessive bleeding after dental extraction |
| Unexpected postsurgical bleeding |
| Hemorrhage from ovarian cysts or corpus luteum, possibly with accompanying pain during ovulation (termed mittleschmerz) |
| Hemorrhage that required blood transfusion |
| Postpartum hemorrhage (PPH), especially delayed PPH (after 24 h; no response to conventional management of menorrhagia) |
Content modified from James et al.12