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Hum. Reprod. Advance Access originally published online on January 4, 2007
Human Reproduction 2007 22(3):635-643; doi:10.1093/humrep/del478
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© The Author 2007. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org
The online version of this article has been published under an open access model. Users are entitled to use, reproduce, disseminate, or display the open access version of this article for non-commercial purposes provided that: the original authorship is properly and fully attributed: the Journal and Oxford University Press are attributed as the original place of publication with the correct citation details given: if an article is subsequently reproduced or disseminated not in its entirety but only in part or as a derivative word this must be clearly indicated. For commercial re-use, please contact journals.permissions@oxfordjournals.org

Can we achieve international agreement on terminologies and definitions used to describe abnormalities of menstrual bleeding? {dagger}

Ian S. Fraser1,5, H.O.D. Critchley2, M.G. Munro3 and M. Broder4

1 Department of Obstetrics and Gynaecology, University of Sydney, Australia 2 Section of Obstetrics and Gynaecology, Department of Reproductive and Developmental Sciences, University of Edinburgh, UK 3 Department of Obstetrics and Gynecology, University of California, Los Angeles, USA and 4 Partnership for Health Analytic Research, Beverly Hills, USA

5 To whom correspondence should be addressed at: Department of Obstetrics and Gynaecology, University of Sydney, NSW 2006, Australia. Tel: +61 2 9351 2478; Fax: +61 2 9351 4560; E-mail: helena{at}med.usyd.edu.au

BACKGROUND: There is considerable worldwide confusion in the use of terminologies and definitions around the symptom of abnormal uterine bleeding (AUB), and these are leading increasingly to difficulties in setting up multinational clinical trials and in interpreting the results of studies undertaken in single centres. An international initiative was established to develop an agreement process to recommend clear, simple terminologies and definitions with the potential for wide acceptance.

METHODS: After widespread consultation with relevant international and national organizations, journal editors and individuals, a modified Delphi process was developed to assess the current use of terminologies followed by a structured face-to-face meeting of 35 clinicians (mostly gynaecologists) and scientists in Washington. Focused small group discussions led to plenary assessment of concepts and recommendations using an electronic keypad voting system.

RESULTS: There was almost universal agreement that poorly defined terms of classical origin used in differing ways in the English medical language should be discarded and that these should be replaced by simple, descriptive terms with clear definitions which have the potential to be understood by health professional and patient alike and which can be translated into most languages. The major recommendations were to replace terms such as menorrhagia, metrorrhagia, hypermenorrhoea and dysfunctional uterine bleeding. Suggestions for potentially suitable replacement terms and definitions are made.

CONCLUSIONS: A simple terminology has been recommended for the description and definition of symptoms and signs of AUB. This manuscript should be a living document and should be part of an ongoing process with international medical and community debate. Classification of causes, investigations and cultural and quality of life issues should be part of the ongoing process.

Key words: abnormal uterine bleeding/definitions/dysfunctional uterine bleeding/menorrhagia/menstruation/terminology

{dagger} This paper is simultaneously published in Fertility and Sterility.

Submitted on September 6, 2006; accepted on November 8, 2006.


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