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Original Article

Menstrual Blood Loss–A Population Study: Variation at different ages and attempts to define normality

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Pages 320-351 | Received 10 Feb 1966, Published online: 09 Jul 2009

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Maureen K. Baldwin, Homa K. Ahmadzia, Diane L. Bartlett, Debbie Bensen-Kennedy, Vidhi Desai, Kristina M. Haley, Sherry L. Herman-Hilker, Amanda M. Kilgore, Roshni Kulkarni, Michelle Lavin, Shari Luckey, Kristen A. Matteson, Kristin Paulyson-Nuñez, Claire S. Philipp, Sachiko Ragosta, Kimberly Rosen, Dawn Rotellini & Angela C. Weyand. (2023) Building the foundation for a community-generated national research blueprint for inherited bleeding disorders: research to advance the health of people with inherited bleeding disorders with the potential to menstruate. Expert Review of Hematology 16:sup1, pages 71-86.
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A. L. da Silva Filho, C. Caetano, A. Lahav, G. Grandi & R. M. Lamaita. (2021) The difficult journey to treatment for women suffering from heavy menstrual bleeding: a multi-national survey. The European Journal of Contraception & Reproductive Health Care 26:5, pages 390-398.
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Toby Richards, Christian Breymann, Matthew J. Brookes, Stefan Lindgren, Iain C. Macdougall, Lawrence P. McMahon, Malcolm G. Munro, Elizabeta Nemeth, Giuseppe M. C. Rosano, Ingolf Schiefke & Günter Weiss. (2021) Questions and answers on iron deficiency treatment selection and the use of intravenous iron in routine clinical practice. Annals of Medicine 53:1, pages 274-285.
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Sayako Akiyama, Erika Tanaka, Olivier Cristeau, Yoshie Onishi & Yutaka Osuga. (2018) Treatment patterns and healthcare resource utilization and costs in heavy menstrual bleeding: a Japanese claims database analysis. Journal of Medical Economics 21:9, pages 853-860.
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Karin S. Coyne, Ahmed M. Soliman, Mary Kay Margolis, Christine L. Thompson & Kristof Chwalisz. (2017) Validation of the 4 week recall version of the Uterine Fibroid Symptom and Health-related Quality of Life (UFS-QOL) Questionnaire. Current Medical Research and Opinion 33:2, pages 193-200.
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Sibel Hacioglu, Aysun Karabulut, Ismail Sari & Ali Keskin. (2016) Haemostatic disorders in reproductive age women with menorrhagia and effects on quality of life. Journal of Obstetrics and Gynaecology 36:8, pages 1041-1045.
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Sarah-Jo Stimpson, Erin C. Rebele & Michael R. DeBaun. (2016) Common gynecological challenges in adolescents with sickle cell disease. Expert Review of Hematology 9:2, pages 187-196.
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Rossella E Nappi, Marco Serrani & Jeffrey T Jensen. (2014) Noncontraceptive benefits of the estradiol valerate/dienogest combined oral contraceptive: a review of the literature. International Journal of Women's Health 6, pages 711-718.
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Erika Tanaka, Mikio Momoeda, Yutaka Osuga, Bruno Rossi, Ken Nomoto, Masakane Hayakawa, Kinya Kokubo & Edward CY Wang. (2014) Burden of menstrual symptoms in Japanese women – an analysis of medical care-seeking behavior from a survey-based study. International Journal of Women's Health 6, pages 11-23.
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Anwaar Ahmed, Asif Ahmad, Nauman Khalid, Angel David, Mansoor Abdullah Sandhu, Muhammad Atif Randhawa & Hafiz Ansar Rasul Suleria. (2014) A Question Mark on Iron Deficiency in 185 Million People of Pakistan: Its Outcomes and Prevention. Critical Reviews in Food Science and Nutrition 54:12, pages 1617-1635.
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Marie Mawet, Fabrice Nollevaux, Dominique Nizet, Fabienne Wijzen, Valérie Gordenne, Niso Tasev, Dimitrije Segedi, Bogdan Marinescu, Andreea Enache, Vadim Parhomenko, Francis Frankenne & Jean-Michel Foidart. (2014) Impact of a new levonorgestrel intrauterine system, Levosert®, on heavy menstrual bleeding: results of a one-year randomised controlled trial. The European Journal of Contraception & Reproductive Health Care 19:3, pages 169-179.
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Johannes Bitzer, Marco Serrani & Annalena Lahav. (2013) Women's attitudes towards heavy menstrual bleeding, and their impact on quality of life. Open Access Journal of Contraception 4, pages 21-28.
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Kristen A Hahn, Lauren A Wise, Anders H Riis, Ellen M Mikkelsen, Kenneth J Rothman, Kristen Banholzer & Elizabeth E Hatch. (2013) Correlates of menstrual cycle characteristics among nulliparous Danish women. Clinical Epidemiology 5, pages 311-319.
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Erika Tanaka, Mikio Momoeda, Yutaka Osuga, Bruno Rossi, Ken Nomoto, Masakane Hayakawa, Kinya Kokubo & Edward C. Y. Wang. (2013) Burden of menstrual symptoms in Japanese women: results from a survey-based study. Journal of Medical Economics 16:11, pages 1255-1266.
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Ronda Copher, Elisabeth Le Nestour, Amy Law, Jennifer Pocoski & Edio Zampaglione. (2013) Retrospective analysis of variation in heavy menstrual bleeding treatments by age and underlying cause. Current Medical Research and Opinion 29:2, pages 127-139.
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LindaJ. Harvey, Cristiana Berti, Amelie Casgrain, Irene Cetin, Rachel Collings, Mirjana Gurinovic, Maria Hermoso, Lee Hooper, Rachel Hurst, Berthold Koletzko, Joy Ngo, Blanca Roman Viñas, Christiane Vollhardt, Vesna Vucic & SusanJ. Fairweather-Tait. (2013) EURRECA—Estimating Iron Requirements for Deriving Dietary Reference Values. Critical Reviews in Food Science and Nutrition 53:10, pages 1064-1076.
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Henri Leminen & Ritva Hurskainen. (2012) Tranexamic acid for the treatment of heavy menstrual bleeding: efficacy and safety. International Journal of Women's Health 4, pages 413-421.
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David F. Archer. (2012) Vascular dysfunction as a cause of endometrial bleeding. Gynecological Endocrinology 28:9, pages 688-693.
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Kenneth E. Fox. (2012) Management of heavy menstrual bleeding in general practice. Current Medical Research and Opinion 28:9, pages 1517-1525.
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Judith Sanchez, Sara Andrabi, Jennifer L. Bercaw & Jennifer E. Dietrich. (2012) Quantifying the PBAC in a Pediatric and Adolescent Gynecology Population. Pediatric Hematology and Oncology 29:5, pages 479-484.
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Luis Bahamondes & M Valeria Bahamondes. (2011) Use of combined oral contraceptives for the management of heavy menstrual bleeding. Expert Review of Obstetrics & Gynecology 6:5, pages 485-489.
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Ian S. Fraser, Susanne Parke, Uwe Mellinger, Andrea Machlitt, Marco Serrani & Jeffrey Jensen. (2011) Effective treatment of heavy and/or prolonged menstrual bleeding without organic cause: pooled analysis of two multinational, randomised, double-blind, placebo-controlled trials of oestradiol valerate and dienogest. The European Journal of Contraception & Reproductive Health Care 16:4, pages 258-269.
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Joe Leigh Simpson, Lynn B. Bailey, Klaus Pietrzik, Barry Shane & Wolfgang Holzgreve. (2011) Micronutrients and women of reproductive potential: required dietary intake and consequences of dietary deficienty or excess. Part II - Vitamin D, Vitamin A, Iron, Zinc, Iodine, Essential Fatty Acids. The Journal of Maternal-Fetal & Neonatal Medicine 24:1, pages 1-24.
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Andrea S. Lukes, Ken Muse, Holly E. Richter, Keith A. Moore & Donald L. Patrick. (2010) Estimating a meaningful reduction in menstrual blood loss for women with heavy menstrual bleeding. Current Medical Research and Opinion 26:11, pages 2673-2678.
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Paige Hertweck & Jennie Yoost. (2010) Common problems in pediatric and adolescent gynecology. Expert Review of Obstetrics & Gynecology 5:3, pages 311-328.
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Ian S Fraser, Sue Langham & Kerstin Uhl-Hochgraeber. (2009) Health-related quality of life and economic burden of abnormal uterine bleeding. Expert Review of Obstetrics & Gynecology 4:2, pages 179-189.
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Álvaro Zapico Goñi, Ramón Lanzón Lacruz, Juan José Parilla Paricio & Francisco J. Hernández Rivas. (2009) The levonorgestrel intrauterine system as an alternative to hysterectomy for the treatment of idiopathic menorrhagia. Gynecological Endocrinology 25:9, pages 581-586.
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A. Elmardi, S. Furara, F. Khan & M. Hamza. (2009) NovaSure impedance controlled system for endometrial ablation: The experience of the first UK reference centre. Journal of Obstetrics and Gynaecology 29:5, pages 419-422.
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Brynja R. Gudmundsdottir, Elin F. Hjaltalin, Gudrun Bragadottir, Arnar Hauksson, Reynir T. Geirsson & Pall T. Onundarson. (2009) Quantification of menstrual flow by weighing protective pads in women with normal, decreased or increased menstruation. Acta Obstetricia et Gynecologica Scandinavica 88:3, pages 275-279.
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Johannes C Huber, Eva-Katrin Bentz, Johannes Ott & Clemens B Tempfer. (2008) Non-contraceptive benefits of oral contraceptives. Expert Opinion on Pharmacotherapy 9:13, pages 2317-2325.
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JillM. Wood, Patricia Barthalow Koch & Phyllis Kernoff Mansfield. (2007) Is My Period Normal? How College-Aged Women Determine the Normality or Abnormality of Their Menstrual Cycles. Women & Health 46:1, pages 41-56.
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Anita C. G. Chua, Ross M. Graham, Debbie Trinder & John K. Olynyk. (2007) The Regulation of Cellular Iron Metabolism. Critical Reviews in Clinical Laboratory Sciences 44:5-6, pages 413-459.
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R. Hurskainen, S. Grenman, I. Komi, E. Kujansuu, R. Luoto, M. Orrainen, K. Patja, J. Penttinen, S. Silventoinen, J. Tapanainen & J. Toivonen. (2007) Diagnosis and treatment of menorrhagia. Acta Obstetricia et Gynecologica Scandinavica 86:6, pages 749-757.
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Sonia Andersson & Miriam Mints. (2007) Thermal balloon ablation for the treatment of menorrhagia in an outpatient setting. Acta Obstetricia et Gynecologica Scandinavica 86:4, pages 480-483.
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Britt Friberg, Ann Kristin Örnö, Annika Lindgren & Stefan Lethagen. (2006) Bleeding disorders among young women: A population-based prevalence study. Acta Obstetricia et Gynecologica Scandinavica 85:2, pages 200-206.
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Bjorn Busund, Lars Espen Erno, Anne Grønmark & Olav Istre. (2003) Endometrial ablation with NovaSure™ GEA, a pilot study. Acta Obstetricia et Gynecologica Scandinavica 82:1, pages 65-68.
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M. K. Oehler & M. C. P. Rees. (2003) Menorrhagia: an update. Acta Obstetricia et Gynecologica Scandinavica 82:5, pages 405-422.
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B. Annibale, E. Lahner, A. Chistolini, C. Gallucci, E. Di Giulio, G. Capurso, O. Luana, B. Monarca & G. Delle Fave. (2003) Endoscopic Evaluation of the Upper Gastrointestinal Tract is Worthwhile in Premenopausal Women with Iron-Deficiency Anaemia Irrespective of Menstrual Flow. Scandinavian Journal of Gastroenterology 38:3, pages 239-245.
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Alison Chappie, Carl May & Margaret Ling. (2001) Is Objective Testing for Menorrhagia in General Practice Practical?: Results from a Qualitative Study. European Journal of General Practice 7:1, pages 13-17.
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Siobán D. Harlow & Oona M.R. Campbell. (2000) Menstrual dysfunction: A missed opportunity for improving reproductive health in developing countries. Reproductive Health Matters 8:15, pages 142-147.
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Alison Chapple. (1998) Iron deficiency anaemia in women of south Asian descent: A qualitative study. Ethnicity & Health 3:3, pages 199-212.
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Alison Chapple, Margaret Ling & Carl May. (1998) General practitioners' perceptions of the illness behaviour and health needs of South Asian women with Menorrhagia. Ethnicity & Health 3:1-2, pages 81-93.
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Ritva Hurskainen, Juha Teperi, Ursula Turpeinen, Seija Grenman, Aarre Kivelä, Erkki Kujansuu, Kimmo Vihko, Merja Yliskoski & Jorma Paavonen. (1998) Combined laboratory and diary method for objective assessment of menstrual blood loss. Acta Obstetricia et Gynecologica Scandinavica 77:2, pages 201-204.
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Alison Chapple, Margaret Ling & Carl May. (1997) Menorrhagia: The need for equity in treatment in Britain. Reproductive Health Matters 5:9, pages 132-138.
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Sally S. Harris & Suzanne Tanner. (1995) Helping Active Women Avoid Anemia. The Physician and Sportsmedicine 23:5, pages 34-48.
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M. Shapley & C. W. E. Redman. (1995) Assessment of menstrual blood loss using a pictorial chart and endometrial sampling within the community. Journal of Obstetrics and Gynaecology 15:2, pages 123-124.
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Nils Milman, Nils Rosdahl, Niels Lyhne, Torben Jørgensen & Niels Graudal. (1993) Iron status in Danish women aged 35–65 years: Relation to menstruation and method of contraception. Acta Obstetricia et Gynecologica Scandinavica 72:8, pages 601-605.
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Christina Somell & Anders Ölund. (1993) Induction of abortion in early pregnancy with mifepristone in conjunction with gemeprost. Acta Obstetricia et Gynecologica Scandinavica 72:1, pages 39-42.
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Björn Andersch, Ian Milsom & Göran Rybo. (1988) An Objective Evaluation of Flurbiprofen and Tranexamic Acid in the Treatment of Idiopathic Menorrhagia. Acta Obstetricia et Gynecologica Scandinavica 67:7, pages 645-648.
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K.-G. Nygren & G. Rybo. (1983) Prostaglandins and Menorrhagia. Acta Obstetricia et Gynecologica Scandinavica 62:sup113, pages 101-103.
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L. Hallberg & L. Rossander. (1982) Bioavailability of Iron from Western-Type Whole Meals. Scandinavian Journal of Gastroenterology 17:1, pages 151-160.
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Jukka Puolakka. (1980) Serum ferritin as a measure of iron stores during pregnancy. Acta Obstetricia et Gynecologica Scandinavica 59:sup95, pages 1-31.
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Paul R. McCurdy. (1977) Microcytic hypochromic anemias. Postgraduate Medicine 61:6, pages 147-151.
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P. G. T. Bye. (1976) Analysis of a Multicentre Trial of a New Low-Dose Oral Contraceptive in Great Britain. Acta Obstetricia et Gynecologica Scandinavica 55:sup54, pages 61-66.
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Bruce M. Camitta & David G. Nathan. (1975) Anemia in Adolescence. Postgraduate Medicine 57:2, pages 143-146.
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Bertil Larsson, Lars Hamberger & Goran Rybo. (1975) Influence of Copper Intrauterine Contraceptive Devices (Cu-7-Iud) on the Menstrual Blood-Loss. Acta Obstetricia et Gynecologica Scandinavica 54:4, pages 315-318.
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Lennart Hahn & Göran Rybo. (1975) Fibrinogen-Fibrin Degradation Products in Menstrual Blood from Women with Normal and Excessive Menstrual Blood Losses. Acta Obstetricia et Gynecologica Scandinavica 54:2, pages 119-127.
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John B. Henry & S.T. Shaw$suffix/text()$suffix/text(). (1973) Quantitation of Menstrual Blood Loss. Postgraduate Medicine 53:2, pages 204-208.
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D. M. Hegsted. (1972) Problems in the use and interpretation of the recommended dietary allowances† . Ecology of Food and Nutrition 1:4, pages 255-265.
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Eigil Guttorm. (1971) Menstrual Bleeding with Intrauterine Contraceptive Devices. Acta Obstetricia et Gynecologica Scandinavica 50:1, pages 9-16.
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