The spontaneous resolution of heavy menstrual bleeding in the perimenopausal years

Objective: To obtain estimates of the rate of spontaneous resolution of heavy menstrual bleeding and to explore any association with specific menstrual symptoms.

Design: Two-year prospective cohort study.

Setting: Seven general practices, with 67 100 registered patients.

Population: All women aged 40-54 years on the practices age-sex registers.

Methods: Baseline postal questionnaire, with follow-up questionnaires sent to naturally menstruating respondents at 6, 12, 18 and 24 months.

Main outcome measures: Rate of spontaneous resolution of heavy menstrual bleeding in naturally menstruating women.

Results: A total of 7121 baseline questionnaires were sent out, with an initial response rate of 63%. We recruited 2051 naturally menstruating women for the prospective cohort study. The spontaneous rate of resolution of heavy menstrual bleeding varied from 8.1% (95% CI 5.3-12%) in women aged 45-49 years, who had resolution without recurrence for 24 months, to 35% (95% CI 30-41%) in women aged 50-54 years, who had resolution without recurrence for 6 months. Rates were lower in those who reported interference with life from heavy menstrual bleeding. There was a strong association between the spontaneous resolution of heavy menstrual bleeding and skipped periods in women aged over 45 years. The association with 'cycle too variable to say' was significant, but weaker.

Conclusion: There is a high prevalence, incidence and significant spontaneous rate of resolution of heavy menstrual bleeding in naturally menstruating women during the perimenopausal years. The rates have potential use for individual women, clinical decisions, devising and implementing interventions and planning the care of populations.