Use of health services associated with increased menstrual loss in the United States

Objective: The study was conducted to estimate the effect of abnormal uterine bleeding on health care use. Study design: Data were taken from the National Health Interview Survey 1999, a nationwide representative sample of the civilian noninstitutionalized population of the United States. The participants who were eligible for the study were 3133 women aged between 18 and 64 years who reported having a natural menstrual period in the last 12 months and in the last 3 months, never having taken medication containing estrogen (except past use of oral contraceptives), and never been told they had reproductive cancer. From these, 328 women were excluded—5 women because they were more than 64 years old and 323 because of the imprecision of their answers related to their menstrual flow. Analysis was performed with the data from 2805 women: 373 having self-described heavy flow and 2432 having normal flow. Results: Age, family size, insurance coverage, perception of health, and flow of menstrual periods are associated with the majority of questions used to measure health care use (P ≤ .05). The odds ratios related to the flow of menstrual periods were all equal to or higher than 1.45 (P ≤ .05), which indicates that women who have a heavier flow are at least 1.45 times as likely to use health care as are women who have a lighter or normal flow. Conclusion: Women having heavy flow of menstrual bleeding are more likely to use health care than women having a normal flow. (Am J Obstet Gynecol 2003;188:343-8.)