An Approach to the Analysis of Menorrhagia *Adapted from an essay for the Dr. Alfred Edward Aust Lawrence undergraduate Prize of the University of Bristol, 1966.

Efforts to control menorrhagia attack the endometrium. It can be dominated by hormones, made redundant by removal of the ovaries, or removed by hysterectomy. These efforts, though effective, are crude in conception because they attack the endometrium, which is only the final common pathway for aU the many unknown factors that contribute to menorrhagia. Destruction or domination of the final common pathway will be effective in preventing the operation of these factors, but it is surely better to take arms against the factors themselves. It is first of all necessary to define menorrhagia. In a sense this is impossible owing to lack of knowledge of the distribution of the volume of menstrual loss lr* the female population at large. It would be easy if it were known that Women could be divided strictly into two groups, those with normal menstruation and those with grossly excessive menstrual loss; and nothing in between. It seems more likely that the volume of menstrual blood loss varies continuously in the population from normal to excessive amounts. If this is the case, then menorrhagia is an arbitrarily defined state arising because one or more of the biological variables controlling the volume of blood-loss has altered to Increase this volume. An analysis of the factors controlling the volume of blood lost in menorrhagia must begin with normal menstruation. Since the endometrium is the final common pathway for these factors, clues as to their nature might be found there.