Assessment of menorrhagia by total menstrual fluid loss

Half of the women presenting with heavy periods do not have objective menorrhagia. In the normal woman, blood is a minority component of total menstrual volume. This paper was designed to examine the hypothesis that the volume of total menstrual fluid loss (TMFL) could be more important than blood loss. A total of 115 women complaining of menorrhagia performed a menstrual collection from which TMFL and menstrual blood loss (MBL) was derived. In women complaining of menorrhagia, mean total menstrual fluid loss is 183.5 ml, with a corresponding menstrual blood loss of 110.3 ml. There is a significant correlation between TMFL and MBL (r = 0.82 (95% CI 0.75 - 0.87), p < 0.001). Blood loss accounts for an average of 60.5% of the total menstrual fluid loss with a wide range of 20 - 99.8%. A change in the proportion of TMFL loss that is blood may well be part of the complex reasons why women present.