1 Menstrual disorders—an overview

Abstract

Abnormal uterine bleeding is an important clinical problem, whether it be excessive menstrual bleeding or intermenstrual bleeding. It is a frequent reason for consultation to general practitioners: menorrhagia and intermenstrual bleeding account for 31 and 9 consultations, respectively, per 1000 (Morbidity Statistics in General Practice, 1981-1982). Abnormal bleeding has become more important in the second half of the twentieth century because women are experiencing more menstrual cycles during their reproductive life. Our early ancestors would have had 1 or 2 years of menstrual cycles during the period of adolescent sterility from menarche to first conception, then pregnancy amenorrhoea followed by about 2-3 years of lactational amenorrhoea. Conception would follow after a few menstrual cycles. With this pattern a fertile woman would give birth to about five children, but would experience only 30 or 40 menstrual cycles during her entire reproductive life. Compare this to the present day: for Western women the average age of the menarche is gradually decreasing while that of the menopause remains constant at 50, the number of pregnancies is reduced to about two and breast-feeding is employed for a shorter time. In addition the increasing use of sterilization has led to more women experiencing natural cycles, as opposed to contraceptive withdrawal bleeds. Thus the woman of today can expect about 400 menstrual cycles during her reproductive life. It is therefore not surprising that the magnitude of menstrual disorders is increasing (Short, 1984).