Unnecessary Hysterectomy due to Menorrhagia and Disorders of Hemostasis: An Example of Overuse and Excessive Demand for Medical Services

Excessive menstrual bleeding—menorrhagia is a common gynecologic disorder affecting women of reproductive age. Subjectively, menorrhagia is defined as a complaint of heavy cyclical menstrual bleeding occurring over several consecutive cycles (Rönnerdag and Odlind, 1999). Objectively, it can be defined as heavy menstrual bleeding lasting for more than 7 days or resulting in the loss of more than 80 mL per menstrual cycle (ACOG Committee on Practice Bulletins—Gynecology, American College of Obstetricians and Gynecologists, 2001). An objective evaluation of the existence of menorrhagia is not simple. Alkaline hematin technique is completely objective measure (extracting hemoglobin from sanitary wear to assess blood loss), but it is impractical out of controlled research settings. Widely used alternative is the pictorial blood loss assessment chart (PBAC) and this is semiobjective method takes into account the number and the degree of staining of items of sanitary wear used. PBAC is easier to perform than the alkaline hematin technique, yet yields more objective results than self-reporting (Warner et al., 2004). Data from literature suggested that approximately 10% of reproductive-aged women had objective evidence of menorrhagia, but studies based on self-reported information suggested that approximately 30% of women of reproductive age were afflicted with heavy menstrual bleeding (Dilley et al., 2002; Shapley et al., 2004). According to our research, out of 115 women who self-report these excessive menstrual bleeding only 55% had actually verified menorrhagia by PBAC (Djukic et al., 2013). Menorrhagia can happen due to anatomic (uterine fibroids, endometrial polyps, endometrial hyperplasia, and pregnancy), endocrinologic (thyroid and adrenal gland dysfunction, pituitary tumors, anovulatory cycles, polycystic ovarial syndrome, obesity, and vasculature imbalance), iatrogenic (steroid hormones, chemotherapy agents, medications) and organic (organ dysfunction infection, bleeding disorders) abnormality (Vilos et al., 2001; Albers et al., 2004).