title: Routine evaluation and treatment of unexplained menorrhagia: do we consider haemostatic disorders?
abstract: OBJECTIVE
  Unexplained menorrhagia can be caused by underlying bleeding disorders. The aim of this study was to investigate the current work-up of menorrhagia in routine gynaecological practice, with a special interest in haemostatic evaluation. Secondly, we investigated the outcome of individualized treatment in our centre.
  
  
  METHODS
  Retrospective medical chart review of 112 consecutive patients referred with menorrhagia to a general gynaecology clinic of a university teaching hospital in the Netherlands between January 2006 and January 2007. In April 2008 we performed a structured telephone interview evaluating the effectiveness of their therapy.
  
  
  RESULTS
  We included 112 patients, whose median age was 42 years. Twenty-nine percent were anaemic (hemoglobin <12.0g/dL). Seventy-one (63%) had unexplained menorrhagia. Only two patients had haemostatic evaluation and neither had von Willebrand's disease. Forty percent (29/71) needed two or more different therapies, 17% (12/71) needed three different therapies and two patients needed a total of seven different therapies. Eight patients underwent hysterectomy, six of them after endometrial ablation. Most patients (80%) were successfully treated medically or surgically and were satisfied with their therapy during follow-up. Eleven patients declined therapy and accepted their heavy periods.
  
  
  CONCLUSIONS
  Haemostatic evaluation in women with unexplained menorrhagia is uncommon in gynaecological practice in our centre. Although most of the patients were satisfied with their treatment, a significant number required hysterectomy and another important proportion had to accept their menorrhagia. We hypothesize that the identification of haemostatic disorders might improve care for these women.
authors.affiliation: Division of Haemostasis and Thrombosis, Department of Haematology, University Medical Centre Groningen, Groningen, The Netherlands. h.m.knol@og.umcg.nl
authors.forename: H Marieke
authors.initials: HM
authors.lastname: Knol
authors.forename: Dick H
authors.initials: DH
authors.lastname: Bogchelman
authors.forename: Hanneke C
authors.initials: HC
authors.lastname: Kluin-Nelemans
authors.forename: Ate G J
authors.initials: AG
authors.lastname: van der Zee
authors.forename: Jan
authors.initials: J
authors.lastname: van der Meer
authors.forename: Karina
authors.initials: K
authors.lastname: Meijer
mesh_terms: D000293:Adolescent; D000328:Adult; D000740:Anemia / Q000209:etiology; D055356:Endometrial Ablation Techniques; D005260:Female; D020141:Hemostatic Disorders / Q000150:complications*; D006801:Humans; D008595:Menorrhagia / Q000209:etiology* / Q000601:surgery / Q000628:therapy; D008875:Middle Aged; D017060:Patient Satisfaction; D012189:Retrospective Studies