Development of a screening tool for identifying women with menorrhagia for hemostatic evaluation


      A study was conducted to develop a short, easy to administer screening tool useful for stratifying women with unexplained menorrhagia for hemostatic testing for underlying bleeding disorders.

      Study Design

      One hundred forty-six women with a physician diagnosis of menorrhagia underwent comprehensive hemostatic testing for the diagnosis of bleeding disorders, including von Willebrand disease, platelet dysfunction, and coagulation factor deficiencies. A 12 page questionnaire of bleeding symptoms was administered. Bleeding symptoms with high predictive values for laboratory hemostatic abnormalities were combined and used as single variables to calculate sensitivity, specificity, and positive and negative predictive values in order to develop a short screening tool to identify females for testing and evaluation.


      A combination of 8 questions in 4 categories resulted in a sensitivity of 82% (95%CI 75-90) for bleeding disorders. Adding a pictorial blood assessment chart score > 100 increased the sensitivity of the screening tool to 95% (95%CI 91-99).


      These results demonstrate the feasibility of a simple questionnaire based screening tool to identify females for testing and evaluation for bleeding disorders.

      Key words

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        • Dilley A.
        • Drews C.
        • Miller C.
        • et al.
        Von Willebrand disease and other inherited bleeding disorders I women with diagnosed menorrohagia.
        Obstet Gynecol. 2001; 97: 630-636
        • Kadir R.A.
        • Economides D.L.
        • Sabin C.A.
        • Owens D.
        • Lee C.A.
        Frequency of inherited bleeding disorders in women with menorrhagia.
        Lancet. 1998; 351: 485-489
        • Edlund M.
        • Blomback M.
        • von Schoultz B.
        • Andersson O.
        On the value of menorrhagia as a predictor for coagulation disorders.
        Am J Hematol. 1996; 53: 234-238
        • Philipp C.S.
        • Faiz A.
        • Dowling N.
        • et al.
        Age and the prevalence of bleeding disorders in women with menorrhagia.
        Obstet Gynecol. 2005; 105: 61-66
        • James A.H.
        • Lukes A.S.
        • Brancazio L.R.
        • Thames E.
        • Ortel T.L.
        Use of a new platelet function analyzer to detect von Willebrand disease in women with menorrhagia.
        Am J Obstet Gynecol. 2004; 191: 449-455
        • Shankar M.
        • Lee C.A.
        • Sabin C.A.
        • Economides D.L.
        • Kadir R.A.
        Von Willebrand disease in women with menorrhagia: a systematic review.
        BJOG. 2004; 11: 734-740
        • Philipp C.S.
        • Dilley A.
        • Miller C.H.
        • et al.
        Platelet functional defects in women with unexplained menorrhagia.
        J Thromb Haemost. 2003; 1: 477-484
        • Bevan J.
        • Maloney K.
        • Hillery C.
        • Gill J.
        • Montgomery R.
        • Paul S.
        Bleeding disorders: a common cause of menorrhagia in adolescents.
        J Pediatr. 2001; 138: 856-861
        • Saxena R.
        • Gupta M.
        • Gupta P.
        • Kashyap R.
        • Choudhry V.
        • Bhargava M.
        Inherited bleeding disorders in Indian women with menorrhagia.
        Hemophilia. 2003; 9: 193-196
        • Rodeghiero F.
        • Castaman G.
        • Dini E.
        Epidemiological investigation of the prevalence of von Willebrand’s disease.
        Blood. 1987; 69: 454-459
        • Lipton R.A.
        Misdiagnosis by milk box.
        Haemophilia. 2003; 9: 235
        • ACOG Committee Opinion
        Menstruation in girls and adolescents: using the menstrual cycle as a vital sign.
        Obstet Gynecol. 2006; 108: 1323-1328
        • Royal College of General Practitioners
        Morbidity statistics from general practice 1981-1982.
        HMSO, London1986
        • Rees M.
        BMJ (Clin Res Ed). 1987; 294: 759-762
        • Oehler M.K.
        • Rees M.C.
        Menorrhagia: an update.
        Acta Obstet Gynecol Scand. 2003; 82: 405-422
        • Lee N.C.
        • Dicker R.C.
        • Rubin G.L.
        • Ory H.W.
        Confirmation of the preoperative diagnoses for hysterectomy.
        Am J Obstet Gynecol. 1984; 150: 283-287
        • Philipp C.S.
        • Miller C.H.
        • Faiz A.
        Screening women with menorrhagia for underlying bleeding disorders: the utility of the platelet function analyzer and bleeding time.
        Haemophilia. 2005; 11: 497-503
        • Higham J.M.
        • O’Brien P.M.S.
        • Shaw R.W.
        Assessment of menstrual blood loss using a pictorial chart.
        BJOG. 1990; 97: 734-739
        • Janssen C.A.H.
        • Scholten P.C.
        • Heintz A.P.M.
        A simple visual assessment technique to discriminate between menorrhagia and normal menstrual blood loss.
        Obstet Gynecol. 1995; 85: 977-982
        • Drews C.D.
        • Dilley A.B.
        • Lally C.
        • Beckman M.G.
        • Evatt B.
        Screening questions to identify women with VWD.
        J Am Med Womens Assoc. 2002; 57: 217-218
        • Warner P.E.
        • Critchley H.
        • Lumsden M.A.
        • Campbell-Brown M.
        • Douglas A.
        • Murray G.D.
        Menorrhagia I: measured blood loss, clinical features, and outcome in women with heavy periods: a survey with follow-up data.
        Am J Obstet Gynecol. 2004; 190: 1216-1223
        • Bonnar J.
        • Sheppard B.L.
        Treatment of menorrhagia during menstruation: randomized controlled trial of ethamsylate, mefenamic acid and tranexamic acid.
        BMJ. 1996; 313: 579-582
        • Fraser I.S.
        • McCarron G.
        • Markham R.
        A preliminary study of factors influencing perception of menstrual blood loss volume.
        Am J Obstet Gynecol. 1984; 149: 788-793
        • Warner P.
        • Critchley H.
        • Lumsden M.A.
        • Campbell-Brown M.
        • Douglas A.
        • Murray G.
        Referral for menstrual problems: cross sectional survey of symptoms, reasons for referral, and management.
        BMJ. 2001; 323: 24-28
        • Sramek A.
        • Eikenboom J.
        • Briet E.
        • Vandenbroucke J.
        • Rosendaal F.R.
        Usefulness of patient interview in bleeding disorders.
        Arch Intern Med. 1995; 155: 1409-1415
        • Rodeghiero F.
        • Castaman G.
        • Tosetto A.
        • et al.
        The discriminant power of bleeding history for the diagnosis of type 1 von Willebrand disease: an international, multicenter study.
        J Thromb Haemost. 2005; 3: 2619-2626
        • Tosetto A.
        • Rodeghiero F.
        • Castaman G.
        • et al.
        A quantitative analysis of bleeding symptoms in type 1 von Willebrand disease: results from a multicenter European study (MCMDM-1 VWD).
        J Thromb Haemost. 2006; 4: 766-773