Heavy menstrual bleeding or menorrhagia
 
 
Excessive menstrual bleeding is a common gynaecological problem, comprising 12% of all gynaecology referrals and is the commonest symptom present during the reproductive life of women. Normal menstruation occurs every 21 to 35 days, lasts 7 or less, and results in 25 ml to 69 ml blood loss per cycle. Some women have heavy periods almost every cycle.
 

Menorrhagia is the medical term for excessive blood loss as heavy menses lasting more than 7 days; an objective definition is menstrual blood loss of more than 80 mL per menstruation [1]. Objective assessment of menstrual blood loss, using the alkaline haematin technique, has been shown to be very accurate and reproducible, but it is not in routine clinical use.
 

It is difficult to quantify menstrual blood loss objectively because it involves techniques that are specialized, time-consuming and require collection of sanitary material by women. As a result, assessment of menorrhagia in clinical practice is usually subjective and often relies on the description provided by the patient. This method is unfortunately inaccurate and there is lack of correlation between a patient's impression and the objective assessment of actual volume of blood loss. In an attempt to address this problem, a pictorial blood loss assessment chart (PBAC) was developed (Figure1) [2].
 
 
 
 

This used a simple scoring system, taking into account the number of sanitary items used and the degree of soiling.
Menorrhagia is a frequent problem that afflicts women from menarche to menopause as well as in the postmenopausal period. It has an enormous impact on women's lives and may affect 25-30% of women at some point during their child-bearing years.

 
 
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