title: An epidemiological survey of symptoms of menstrual loss in the community.
abstract: BACKGROUND
  For the early detection of gynaecological malignancy, guidance based on presenting symptoms exists to aid a general practitioner (GP) in determining who to investigate or refer. The evidence for this advice is based on the prevalence of symptoms in women with gynaecological malignancy or within specialist clinics. There are no studies on the incidence of symptoms within the community.
  
  
  OBJECTIVE
  To provide an estimate of the incidence of self-reported symptoms of menstrual loss in the community population of a single general practice.
  
  
  METHODS
  A prospective population-based cohort study of women identified through a baseline postal survey and followed 6 and 12 months later.
  
  
  METHODS
  An urban general practice with four partners and 10,000 registered patients.
  
  
  METHODS
  A postal baseline survey was undertaken on all women aged 18-54 years on the practice age-sex register. Responders who consented to follow-up were sent further questionnaires at 6 and 12 months. All questionnaires enquired about the presence or absence of symptoms related to vaginal bleeding. Twelve-month cumulative incidence rates were calculated using responders to the baseline, 6-month and 12-month questionnaires.
  
  
  RESULTS
  A total of 2435 questionnaires were initially sent out at baseline and 1513 (62%) women replied to all three questionnaires. The 12-month cumulative incidence of symptoms in menstruating women was: menorrhagia 25% (95% confidence interval [CI] = 22 to 29); periods heavier than usual, 21% (95% CI = 18 to 23); change in pattern of cycle, 29% (95% CI = 26 to 32); short cycle 21% (95% CI = 19 to 24); long cycle 15% (95% CI = 13 to 18); intermenstrual bleeding 17% (95% CI = 14 to 19); postcoital bleeding 6% (95% CI = 5 to 8); prolonged period 9% (95% CI = 7 to 11).
  
  
  CONCLUSIONS
  The development of symptoms of menstrual loss among women in the community is common, in contrast to the rarity of gynaecological malignancy. This raises concern about the usefulness of current guidelines, based on symptoms, advising women when to consult, and for the early detection of gynaecological malignancy in the community and primary care.
authors.affiliation: Primary Care Sciences Research Centre, Keele University, Staffordshire. m.shapley@cphc.keele.ac.uk
authors.forename: Mark
authors.initials: M
authors.lastname: Shapley
authors.forename: Kelvin
authors.initials: K
authors.lastname: Jordan
authors.forename: Peter R
authors.initials: PR
authors.lastname: Croft
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D004739:England / Q000453:epidemiology; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008595:Menorrhagia / Q000453:epidemiology*; D008875:Middle Aged; D014504:Urban Health