The FIGO Recommendations on Terminologies and Definitions for Normal and Abnormal Uterine Bleeding

ABSTRACT

Over the past 5 years there has been a major international discussion aimed at reaching agreement on the use of well-defined terminologies to describe the normal limits and range of abnormalities related to patterns of uterine bleeding. This article builds on concepts previously presented, which include the abandonment of long-used, ill-defined, and confusing English-language terms of Latin and Greek origin, such as menorrhagia and metrorrhagia. The term dysfunctional uterine bleeding should also be discarded. Alternative terms and concepts have been proposed and defined. The terminologies and definitions described here have been comprehensively reviewed and have received wide acceptance as a basis both for routine clinical practice and for comparative research studies. It is anticipated that these terminologies and definitions will be reviewed again on a regular basis through the International Federation of Gynecology and Obstetrics Menstrual Disorders Working Group.

KEYWORDS

Menstruation - menstrual cycle - abnormal uterine bleeding

REFERENCES

• 1 Fraser I S, Inceboz U S. Defining disturbances of the menstrual cycle. In: O'Brien P NS, Cameron I T, MacLean A B, eds. Disorders of the Menstrual Cycle. London, UK: RCOG Press; 2000: 151-152
• 2 Fraser I S, Critchley H OD, Munro M G, Broder M. Writing Group for this Menstrual Agreement Process . A process designed to lead to international agreement on terminologies and definitions used to describe abnormalities of menstrual bleeding.  Fertil Steril. 2007;  87 (3) 466-476
• 3 Fraser I S, Critchley H OD, Munro M G, Broder M. Can we achieve international agreement on terminologies and definitions used to describe abnormalities of menstrual bleeding?.  Hum Reprod. 2007;  22 (3) 635-643
• 4 Woolcock J G, Critchley H OD, Munro M G, Broder M S, Fraser I S. Review of the confusion in current and historical terminology and definitions for disturbances of menstrual bleeding.  Fertil Steril. 2008;  90 (6) 2269-2280
• 5 Jensen J E, Parke S, Mellinger U, Machlitt A, Fraser I S. Effective treatment of heavy menstrual bleeding with estradiol valerate and dienogest, a randomized controlled trial.  Obstet Gynecol. 2010;  117 (4) 777-787
• 6 Fraser IS, Romer T, Parke S, Zeun S, Mellinger U, Machlitt A, Jensen J T. Effective treatment of heavy and/or prolonged menstrual bleeding with an oral contraceptive containing oestradiol valerate and dienogest: a randomised, double-blind Phase III trial.  Hum Reprod. 2011;  26 2698-2708
• 7 Critchley H OD, Munro M G, Broder M, Fraser I S. A five-year international review process concerning terminologies, definitions, and related issues around abnormal uterine bleeding.  Semin Reprod Med. 2011;  29 (5) 377-382
• 8 Munro M G, Broder M, Critchley H OD, Matteson K, Haththotuwa R, Fraser I S. An international response to questions about terminologies, investigation, and management of abnormal uterine bleeding: use of an electronic audience response system.  Semin Reprod Med. 2011;  29 (5) 436-445
• 9 Brook R H, Chassin M R, Fink A, Solomon D H, Kosecoff J, Park R E. A method for the detailed assessment of the appropriateness of medical technologies.  Int J Technol Assess Health Care. 1986;  2 (1) 53-63
• 10 Critchley H OD, Maybin J A. Molecular and cellular causes of abnormal uterine bleeding of endometrial origin.  Semin Reprod Med. 2011;  29 (5) 400-409
• 11 Munro M G, Critchley H OD, Fraser I S. The flexible FIGO classification concept for underlying causes of abnormal uterine bleeding.  Semin Reprod Med. 2011;  29 (5) 391-399
• 12 Dueholm M. Levonorgestrel-IUD should be offered before hysterectomy for abnormal uterine bleeding without uterine structural abnormalities: there are no more excuses!.  Acta Obstet Gynecol Scand. 2009;  88 (12) 1302-1304
• 13 Belsey EM, Machin D, d'Arcangues C. The analysis of vaginal bleeding patterns induced by fertility regulating methods. World Health Organization Special Programme of Research, Development and Research Training in Human Reproduction.  Contraception. 1986;  34 (3) 253-260
• 14 Working Party for Guidelines for the Management of Heavy Menstrual Bleeding . An evidence-based guideline for the management of heavy menstrual bleeding.  N Z Med J. 1999;  112 (1088) 174-177
• 15 National Institute for Health and Clinical Excellence .Clinical Guideline 44; Heavy menstrual bleeding. Available at: http://www.nice.org.uk/nicemedia/pdf/CG44FullGuideline.pdf Accessed May 19, 2011
• 16 Hallberg L, Nilsson L. Determination of menstrual blood loss.  Scand J Clin Lab Invest. 1964;  16 244-248
• 17 Newton J R, Barnard G, Collins W. A rapid method for measuring menstrual blood loss using automatic extraction.  Contraception. 1977;  16 269-282
• 18 Fraser I S. Bleeding arising from the use of exogenous steroids.  Best Pract Res Clin Obstet Gynaecol. 1999;  13 (2) 203-222
• 19 Fraser I S, Warner P, Marantos P A. Estimating menstrual blood loss in women with normal and excessive menstrual fluid volume.  Obstet Gynecol. 2001;  98 806-814
• 20 Soules M R, Sherman S, Parrott E et al.. Stages of Reproductive Aging Workshop (STRAW).  J Womens Health Gend Based Med. 2001;  10 (9) 843-848
• 21 Snowden R J, Christian B eds.. Patterns and Perceptions of Menstruation (a World Health Organization International Study). London, UK: Croom Helm; 1983: 339
• 22 Rodriguez G, Faundes-Latham A, Atkinson L E. An approach to the analysis of menstrual patterns in the critical evaluation of contraceptives.  Stud Fam Plann. 1976;  7 (2) 42-51
• 23 Belsey E M, Farley T MM. The analysis of menstrual bleeding patterns: a review.  Contraception. 1988;  38 (2) 129-156
• 24 Belsey E M, Pinol A P. Menstrual bleeding patterns in untreated women. Task Force on Long-Acting Systemic Agents for Fertility Regulation.  Contraception. 1997;  55 (2) 57-65
• 25 Treloar A E, Boynton R E, Behn B G, Brown B W. Variation of the human menstrual cycle through reproductive life.  Int J Fertil. 1967;  12 (1 Pt 2) 77-126
• 26 Hallberg L, Högdahl A M, Nilsson L, Rybo G. Menstrual blood loss—a population study. Variation at different ages and attempts to define normality.  Acta Obstet Gynecol Scand. 1966;  45 (3) 320-351