Defining Normal and Abnormal Uterine Bleeding
Over the past 5 years there has been a major international discussion aimed at reaching agreement on the use of well-defined terminologies to describe the normal limits and range of abnormalities related to patterns of uterine bleeding. This article builds on concepts previously presented, which include the abandonment of long-used, ill-defined, and confusing English-language terms of Latin and Greek origin, such as menorrhagia and metrorrhagia. The term dysfunctional uterine bleeding should also be discarded. Alternative terms and concepts have been proposed and defined. The terminologies and definitions described here have been comprehensively reviewed and have received wide acceptance as a basis both for routine clinical practice and for comparative research studies. It is anticipated that these terminologies and definitions will be reviewed again on a regular basis through the International Federation of Gynecology and Obstetrics Menstrual Disorders Working Group.
Over the past decade it has become abundantly clear that many terms used to describe menstrual symptoms and causes of abnormal menstrual bleeding are ill defined and confusing. This situation has led to difficulties in interpreting the scientific and clinical literature, in reaching agreement on the use of various therapies, and in the establishment of acceptable clinical trials. Indeed, two phase 3 clinical trials on management of heavy menstrual bleeding with a novel estradiol-based oral contraceptive, using identical protocols, have just been completed on opposite sides of the Atlantic. These two trials performed in the United States/Canada and Europe/Australia (Clinical Trials.gov identifiers NCT00293059 and NCT00307801) were set up separately, primarily because of difficulties in defining the study populations using current terminologies.
A formal initiative was established with an international workshop in Washington, D.C., in 2005, which primarily addressed the most obvious and confusing of issues around terminologies, definitions, and classifications of abnormal uterine bleeding but also addressed issues that were less prominent at that time. These additional issues included quality of life and obvious patient-based considerations; cultural issues, and controversies around investigations and management.
A high level of agreement on terminologies was obtained following extensive discussion and use of an audience keypad responder system. It was strongly recommended that poorly defined and confusing terminologies such as menorrhagia, metrorrhagia, and dysfunctional uterine bleeding be abandoned. In their place should be substituted clear and simple terms that women and men in the general community could understand and could be easily translated into other languages. These terms should be defined, and ideally the definitions should be based on statistics derived from population studies.
These initial discussions and publications were followed by lectures, teleconferences, and the establishment of the International Federation of Gynecology and Obstetrics (FIGO) Menstrual Disorders Working Group. Members of this group met again for a Pre-Congress Workshop immediately prior to the FIGO World Congress of Gynecology and Obstetrics in Cape Town in October 2009 and reviewed a series of recommendations, which are described here. Many of these recommendations were posed as questions through an audience responder system to a large multicultural audience at a symposium on "Abnormal Uterine Bleeding" within the main scientific program of the FIGO World Congress. These audience responses are addressed in detail in the article by Munro et al in this issue.
Abstract and Introduction
Abstract
Over the past 5 years there has been a major international discussion aimed at reaching agreement on the use of well-defined terminologies to describe the normal limits and range of abnormalities related to patterns of uterine bleeding. This article builds on concepts previously presented, which include the abandonment of long-used, ill-defined, and confusing English-language terms of Latin and Greek origin, such as menorrhagia and metrorrhagia. The term dysfunctional uterine bleeding should also be discarded. Alternative terms and concepts have been proposed and defined. The terminologies and definitions described here have been comprehensively reviewed and have received wide acceptance as a basis both for routine clinical practice and for comparative research studies. It is anticipated that these terminologies and definitions will be reviewed again on a regular basis through the International Federation of Gynecology and Obstetrics Menstrual Disorders Working Group.
Introduction
Over the past decade it has become abundantly clear that many terms used to describe menstrual symptoms and causes of abnormal menstrual bleeding are ill defined and confusing. This situation has led to difficulties in interpreting the scientific and clinical literature, in reaching agreement on the use of various therapies, and in the establishment of acceptable clinical trials. Indeed, two phase 3 clinical trials on management of heavy menstrual bleeding with a novel estradiol-based oral contraceptive, using identical protocols, have just been completed on opposite sides of the Atlantic. These two trials performed in the United States/Canada and Europe/Australia (Clinical Trials.gov identifiers NCT00293059 and NCT00307801) were set up separately, primarily because of difficulties in defining the study populations using current terminologies.
A formal initiative was established with an international workshop in Washington, D.C., in 2005, which primarily addressed the most obvious and confusing of issues around terminologies, definitions, and classifications of abnormal uterine bleeding but also addressed issues that were less prominent at that time. These additional issues included quality of life and obvious patient-based considerations; cultural issues, and controversies around investigations and management.
A high level of agreement on terminologies was obtained following extensive discussion and use of an audience keypad responder system. It was strongly recommended that poorly defined and confusing terminologies such as menorrhagia, metrorrhagia, and dysfunctional uterine bleeding be abandoned. In their place should be substituted clear and simple terms that women and men in the general community could understand and could be easily translated into other languages. These terms should be defined, and ideally the definitions should be based on statistics derived from population studies.
These initial discussions and publications were followed by lectures, teleconferences, and the establishment of the International Federation of Gynecology and Obstetrics (FIGO) Menstrual Disorders Working Group. Members of this group met again for a Pre-Congress Workshop immediately prior to the FIGO World Congress of Gynecology and Obstetrics in Cape Town in October 2009 and reviewed a series of recommendations, which are described here. Many of these recommendations were posed as questions through an audience responder system to a large multicultural audience at a symposium on "Abnormal Uterine Bleeding" within the main scientific program of the FIGO World Congress. These audience responses are addressed in detail in the article by Munro et al in this issue.