Objective: To determine whether the 30-year-old definition of menorrhagia (menstrual blood loss of 80 ml or more) is still valid in gynecological practice today.
Study design: Of 313 Dutch women, recruited from gynecological practice, the menstrual blood loss of one bleeding episode was objectively measured and related to the women's hemoglobin concentrations as well as their serum ferritin levels. Also, the 95th percentile of menstrual blood loss was calculated of women with normal hematological parameters, representing an upper normal limit.
Results: The percentage of women suffering from anemia exceeded the overall mean above 120 ml of menstrual blood loss. The 95th percentile of menstrual blood loss of women with normal hemoglobin concentrations (12 g/dl or above) and with normal serum ferritin levels (16 microg/l or above) was 115 ml.
Conclusion: The risk of developing anemia from heavy menstrual bleeding is substantially increased at a menstrual blood loss level of 120 ml, and not, like the current definition of menorrhagia suggests, at 80 ml.