Psychosocial and other characteristics of women complaining of menorrhagia, with and without actual increased menstrual blood loss Ritva Hurskainen a,b, * , Anna-Mari Aalto b , Juha Teperi b , Seija Grenman c , Aarre Kivela È d , Erkki Kujansuu e , Sirkku Vuorma b , Merja Yliskoski f , Jorma Paavonen a Objective To discover whether psychosocial factors can explain why many women with normal menstrual blood loss seek care for menorrhagia. Design Cross-sectional comparative study of women referred for menorrhagia. Setting Gynaecology departments of all ®ve university teaching hospitals in Finland. Sample Two hundred and twenty-six women aged 35-49 years complaining of menorrhagia. Main outcome measures Several psychosocial factors, seeking medical attention, menstrual blood loss. Results Twenty-nine percent of the women had their menstrual blood loss in the normal range (menstrual blood loss ,60 mL). By univariate analysis, unemployment, anxiety, perceived inconvenience, abdominal pain, haemoglobin level and serum ferritin concentration distinguished this group of women from those with true menorrhagia. Unemployment, perceived inconvenience, abdominal pain and serum ferritin remained signi®- cant variables by multivariate analysis. Conclusions A signi®cant proportion of women with complaints of menorrhagia have their measured menstrual blood loss within the normal range. Psychosocial factors can have an impact on their seeking health care. Better understanding of the factors, which explain complaints of menorrhagia in women with normal bleeding could improve both medical outcomes and reduce the cost of treatment for menorrhagia. INTRODUCTION Up to one-third of women have occasionally experi- enced heavy periods during their reproductive years 1 . However, only half of those who complain of excessive bleeding have objective menorrhagia (80 mL per cycle) when menstrual blood loss is actually measured 2±4 . Factors other than the actual amount of blood loss would appear to affect the threshold for seeking care. In previous studies on the psychological and demographic determinants of the perception of menorrhagia, menstrual blood loss has not been measured 5±7 objectively. In the only study addressing the amount of MBL, a self-rated symptom score was used 8 . Lower social status was asso- ciated with seeking care in spite of normal menstrual blood loss. Our hypothesis was that women seeking care for menorrhagia despite of normal menstrual blood loss have more psychosocial problems than women with true menorrhagia. We tested this hypothesis in a group of women referred to gynaecology clinics because of menorrhagia. We included a wide range of variables most of which have been linked to the menstrual cycle in previous studies. METHODS We studied 226 women enrolled in a randomised multicentre trial of treatments for menorrhagia during years 1994±1998 in all ®ve university clinics in Finland. All the women were referred from health centres or private gynaecologists to specialist clinics because of menorrhagia. They were assessed by their medical history, physical examination, cervical smear, transvagi- nal ultrasonography and endometrial biopsy. When clini- cally indicated hysteroscopy was also performed. Women with endometrial or ovarian pathology were excluded, as were those with previous malignancies, urinary and bowel symptoms or discomfort due to large ®broids. All the women were regarded as eligible for q RCOG 2001 British Journal of Obstetrics and Gynaecology PII: S0306-5456(00)00040-1 British Journal of Obstetrics and Gynaecology March 2001, Vol. 108, pp. 281±285 www.bjog-elsevier.com a Department of Obstetrics and Gynaecology, University of Helsinki, Finland b Health Services Research Unit, Stakes, Finland c Department of Obstetrics and Gynaecology, University of Turku, Finland d Department of Obstetrics and Gynaecology University of Oulu, Finland e Department of Obstetrics and Gynaecology, University of Tampere, Finland f Department of Obstetrics and Gynaecology, University of Kuopio, Finland * Correspondence: Dr R. Hurskainen, Stakes, Siltasaarenk.18, 00531 Helsinki, Finland.