A new method for measuring menstrual blood loss and its use in screening women before endometrial ablation

OBJECTIVE: 1. To develop and validate a method for measuring menstrual blood loss in a routine setting, and 2. To assess the value of measuring menstrual blood loss before endometrial ablation. DESIGN: A prospective, observational study. SETTING: Four Yorkshire hospitals: The General Infirmary at Leeds, St. James's University Hospital, Leeds, St. Luke's Hospital, Bradford and The Friarage Hospital, Northallerton. PARTICIPANTS: Three hundred and seventy-two women who had been offered endometrial ablation for menorrhagia. MEASUREMENT: Sanitary material was washed with a nonionic detergent in a known volume of water. The haemoglobin in a sample of solution was measured by mixing with sodium carbonate for spectrophotometric analysis. INTERVENTIONS: The menstrual blood loss result was revealed to each women. Electrosurgical endometrial ablation was performed for those who decided to have surgery. MAIN OUTCOME MEASURES: Proportion of women with normal menstrual blood loss (< or = 80 mL) who avoided surgery. Comparison of endometrial ablation outcome in women with and without genuine menorrhagia. RESULTS: Thirty-six women (10%) with normal menstrual blood loss who declined surgery continued to avoid surgery after a mean of 27 months. Two hundred and ninety-two women were followed up for one year after endometrial ablation. Those with genuine menorrhagia (n = 122) were less likely to be dissatisfied (9% vs 18%) (OR 2.5, 95% CI 1.1-4.7) or to require hysterectomy (4% vs 7%) (OR 1.8, 95% CI 0.6-5.2) than women with normal menstrual blood loss (n = 170). CONCLUSIONS: The objective diagnosis of menorrhagia can be undertaken in a routine setting and may provide some women, who have a normal menstrual blood loss, sufficient reassurance to refrain from surgery. Women with genuine menorrhagia have a better outcome after endometrial ablation than those with normal menstrual blood loss.