Menorrhagia and hemoglobin levels

Abstract

Metrorrhagia and menorrhagia are frequent complaints in gynecological emergencies, and anemia is the main criterion that will guide treatment [1]. The objective of this study was to determine whether clinical findings such as number of days of bleeding, pulse rate, and amount of blood lost correlate with the laboratory finding of anemia (defined as a hemoglobin concentration b11.5 g/dL). After signing informedconsent,womenwith abnormal bleeding (≥1 day of heavy bleeding) who had not changed their sanitary napkin in the last 30 min were recruited for the study. Inevitable miscarriage, ectopic pregnancy, and having changed sanitary napkins in the last 30 min were exclusion criteria. Total blood cell count at presentation, pulse rate, and number of days of bleeding were registered. The number of blood-saturated gauze pads used to remove all blood from the vagina and cervix provided an estimation of current blood loss. The study was approved by the institutional review board. The characteristics of the participants are shown in Table 1. Multiple regression analysis was performed with hemoglobin level as the dependent variable and pulse rate, number of days of bleeding, and number of blood-saturated gauze pads as independent variables. The sample size was calculated based on α (probability of a type 1 error)=0.01; β (probability of a type 2 error)=0.05; and r (correlation between menstrual blood loss and hemoglobin levels)=−0.37 [2]. Hemoglobin levels, pulse rate, number of days of bleeding (N7 or ≤7), and number of gauze pads used (N1 and ≤1) were used as regressors. The regression was unacceptable (R adj =14.2%), but the overall relationship was significant (F3,105=6.99, P=0.0002). With other variables held constant, hemoglobin levels were negatively related to number of days of bleeding, pulse rate, and number of gauze pads used. Levels decreased by 1.26 g/dL when the participants reported more than 7 days of bleeding (95% confidence interval [CI], −1.91 to −0.61); by 0.01 g/dL for each increase in pulse rate of 1 beat per minute (95% CI, −0.03 to −0.008); and by 1.16 g/dL when more than 1 gauze pad was used (95% CI, −2.48 to −0.15). However, the only significant decrease occurred in patients who reported more than 7 days of bleeding (t105=3.86, P=0.0002). The correlation between number of days of bleeding and hemoglobin level was −0.3 (95% CI, −0.47 to −0.12) (Spearman rank correlation, P=0.001) (Fig. 1).