In the last 20 years, our understanding of the needs of women with bleeding disorders has increased and our ability to manage their needs has improved. It is now well-established that heavy menstrual bleeding, or menorrhagia, is the most common symptom that women with bleeding disorders experience. Over the last 20 years, data have been published about the prevalence of menorrhagia in women with bleeding disorders. These data are summarized in Table 1. It has been well-established that menorrhagia is more prevalent among women with bleeding disorders. In the last 13 years, it has
also been established that bleeding disorders are more prevalent among women with menorrhagia. Among women with menorrhagia, the prevalence of von Willebrand disease (VWD) has been reported to be 5–20% [1–7] with an overall estimate of 13%  based on a systematic review. The prevalence of VWD and other bleeding Sirolimus disorders in women with menorrhagia is summarized in Table 2. There are limited data regarding the prevalence of bleeding disorders among adolescents with menorrhagia, but in the last 8 years, it has become apparent that they are at least as likely to have an underlying
bleeding disorder as adult women with heavy menstrual bleeding. The prevalence of bleeding disorders in adolescents with menorrhagia (from studies of inpatients, outpatients and patients referred to a haemophilia MCE treatment centre) are summarized in Table 3. Menorrhagia is defined as heavy menstrual bleeding that lasts for more than 7 days  or results in the loss of more than 80 mL of blood per RNA Synthesis inhibitor menstrual cycle . As measuring actual menstrual blood
loss is not feasible in clinical practice, Higham et al. devised a pictorial blood assessment chart (PBAC) as an alternative . In the investigators’ original study, women compared the degree of saturation of their pads and tampons with those depicted on a chart. Lightly stained pads or tampons obtained a score of 1, moderately stained pads or tampons a score of 5, and soaked pads or tampons a score of 20. The scores were summed and a total score of greater than 100 per cycle was associated with a menstrual blood loss of greater than 80 mL. A drawback of the use of the chart is that it must be completed prospectively and its results are not available at the time of an initial evaluation. Additionally, the validity of the chart remains uncertain [11,12]. Nonetheless, in the last 5 years, the PBAC has been used successfully to monitor response to treatment in studies of women with bleeding disorders [13,14]. In most situations, however, the practitioner must rely on a menstrual history and clinical impression to decide whether a woman has menorrhagia. Warner et al. attempted to assess the volume of blood loss by means of specific clinical features.