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P123 What next for assessment of menstrual bleeding problems?
  1. P Warner
  1. Ussher Institute, University of Edinburgh, Edinburgh, UK


Background Menstrual problems can have profound impact on quality-of-life and role-functioning. Heavy menstrual bleeding (HMB), with potential adverse impact on iron status, seems to be of most clinical concern. However HMB usually occurs in combination with other menstrual problems (period pain, cyclic peri-menstrual symptoms). Many women will have some degree of adverse impact on quality-of-life, for one week in four, over many years of what should be the prime of their lives, accumulating to a substantial life-time deficit.

In recent decades research assessment of HMB has utilised laboratory assay of menstrual blood loss volume, via collection of all used sanitary products (MBL assay). This is unfeasible and/or distasteful to many women, and escalates research costs. The alternative measure often used – pictogram diary of menstrual blood loss – needs frequent re-calibration against developments in menstrual protection. Baseline assessment by either measure imposes considerable delay to initiation of treatment. Neither assessment takes any account of other menstrual problems, nor impact on quality-of-life.

The 2007 NICE Guideline for HMB recommended “interventions should aim to improve quality-of-life” yet, even 9 years later, use of quality-of-life measures in routine clinical practice remains rare. What is urgently needed is a brief menstrual problem assessment that has potential utility for clinical and research use.

Methods Survey of 952 women aged 25 to 49 years old referred (to 3 Scottish hospital gynaecology clinics) with HMB/menstrual problems. Data collected comprised baseline questionnaires assessing menstrual symptoms/problems [including 16-item Menstrual Problem Measure (MPM)]; plus, for a subset (n = 697), Eysenck Personality Inventory, SF-36, General Health Questionnaire; and for a subset of these (n = 225), prospective menstrual diary and MBL assay. Principal components analysis and multivariate modelling of inter-relationships of components with symptoms/problems, demographic variables and other measures.

Results Many women reported more than one menstrual problem – only 10% reported solely HMB as severe’ problem. The MPM items were interrelated, but reduced to 3 principal components (essentially ‘heaviness’, ‘cyclic symptoms including pain’, and ‘change in cycle’). All SF-36 scale scores correlated significantly with ‘heaviness’ and ‘cyclic/pain’, particularly the latter with SF36 Bodily Pain (r = 0.5, p < 0.0001). Furthermore, all but two of the SF36 scales correlated with ‘change’. The validity of the components was supported by additional analyses against other study variables (including MBL assay).

Conclusion MPM reflects quality-of-life impact of menstrual problems and is simple/quick-to-complete. It also describes menstrual experience in a way likely to make sense to women, and to be helpful to clinical consultations.

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