Santer Miriam, Wyke Sally, Warner Pamela
MRC Health Services Research Fellow, Division of Community Health Sciences, University of Edinburgh Medical School, Edinburgh, UK.
BMC Womens Health. 2007 Jun 2;7:8. doi: 10.1186/1472-6874-7-8.
Heavy menstrual bleeding is a common symptom amongst women of reproductive age, yet questions remain about why some women experience this as a problem while others do not. We investigated the concerns of women who reported heavy menstrual bleeding on questionnaire.
A cross-sectional postal survey and qualitative interviews were carried out amongst a community-based sample of women in Lothian, Scotland. 906 women aged 25 to 44 reported heavy or very heavy periods in response to a postal survey of 2833 women registered with 19 general practices. Amongst those who had reported heavy menstrual bleeding, analysis was carried out of responses to the free text questionnaire item, "What bothers you most about your periods?" In addition, 32 of these women participated in qualitative interviews and their accounts were analysed to explore how menstrual symptoms and 'problems' with periods were experienced.
Even amongst this subgroup of women, selected on the basis of having reported their periods as heavy in the survey, pain was the aspect of their periods that 'most bothered' them, followed by heaviness, mood changes or tiredness, and irregularity or other issues of timing. Interviewees' accounts similarly suggested that a range of menstrual symptoms were problematic and some women did not disentangle which was worst. Judgements of periods as a problem were based on the impact of menstrual symptoms on daily life and this was contingent on social circumstances such as type of paid work and other responsibilities. Although women spoke readily of whether their periods were a problem, there was less clarity in accounts of whether or not menstrual loss was 'heavy'; women said they made judgements based on what was normal for them, degree of difficulty in containing blood loss and pattern of loss.
Women with heavy periods are bothered by a range of menstrual symptoms and their impact on everyday life. Clinical emphasis should be on clarifying the presenting problem and providing help and advice for this, as well as on excluding serious disease. Sometimes simple approaches, such as help with analgesia, may be all that is required.
月经过多是育龄女性的常见症状，但对于为何有些女性将其视为问题而有些女性却不然，仍存在疑问。我们通过问卷调查研究了报告月经过多的女性的担忧。
在苏格兰洛锡安地区以社区为基础对女性样本进行了横断面邮寄调查和定性访谈。在对19家全科诊所登记的2833名女性进行的邮寄调查中，906名年龄在25至44岁的女性报告有月经过多或非常多的情况。在那些报告月经过多的女性中，对自由文本问卷项目“月经最困扰你的是什么？”的回答进行了分析。此外，其中32名女性参与了定性访谈，并对她们的叙述进行分析，以探讨月经症状和月经“问题”是如何被体验的。
即使在这个基于调查中报告月经过多而选出的女性亚组中，疼痛仍是她们月经中“最困扰”她们的方面，其次是经量多、情绪变化或疲劳，以及月经不规律或其他时间问题。受访者的叙述同样表明一系列月经症状都存在问题，一些女性无法分清哪种症状最严重。将月经视为问题的判断基于月经症状对日常生活的影响，这取决于社会环境，如工作类型和其他责任。尽管女性很容易说出她们的月经是否是个问题，但对于经量是否“过多”的叙述则不太清晰；女性表示她们是根据自身的正常情况、控制失血的难度程度和失血模式来做出判断的。
月经过多的女性受到一系列月经症状及其对日常生活影响的困扰。临床重点应在于明确呈现的问题并为此提供帮助和建议，以及排除严重疾病。有时简单的方法，如止痛帮助，可能就足够了。
