June 27, 2009

I learned about menorrhagia and other female reproductive oddities and abnormalities in the esoteric world of the fertility clinic. It is a strange environment, staffed by female nurses, counsellors, and secretaries, but headed entirely by male doctors. Mine was not even an exception to the general rule: this pattern remains common among fertility clinics everywhere except the Middle East, where the gender division is of a different kind.

A brief definition. (Don't squirm: it is relevant.) Menorrhagia is defined as regularly having abnormally heavy menstrual periods, with blood loss per cycle of more than 80 mL.

It is the nature of research to reflect its society, and medical research is no exception. Obviously such heavy cycles can be disruptive to a woman's activities. but at the extremes, menorrhagia can also impact severely on many women's health. It can cause anaemia, and itself be a symptom of underlying health problems. Treatment focuses upon reducing flow to a "normal" average, either through pharmacology or what is now day surgery (which most commonly involves some variant of freezing, burning, or otherwise destroying living endometrial tissue).

Yet in all the journals I found myself reading, only one study examined the actual rate of associated anaemia, finding that only 25% of women with menorrhagia also had anaemia. Every other comprehensive survey of menorrhagia was premised entirely upon quality of life issues.

Interestingly, no study I have yet found examines whether a tendency toward menorrhagia might have other advantages. None have looked at such factors as whether (in the absence of other medical conditions, such as fibroids) menorrhagic women are more or less likely to have specific complications in childbirth, birth weight of the neonate, or child development.

In our society, after checking for and treating any underlying medical conditions, women and physicians alike invariably come to a similar conclusion: if a woman presents with menorrhagia and finds it an obstacle in her daily life (presumably beyond the normal obstacle of menstruation, although how exactly would one measure that?), it is desirable to eliminate it. No other factors are relevant.

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