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AFHSC Surveillance Case Definitions
Case Definition and Incidence Rules
For surveillance purposes, a case of menorrhagia is defined as:
One hospitalization with any of the defining diagnoses of menorrhagia (see ICD9 and ICD10 code lists below) in the primary diagnostic position; or
Two outpatient medical encounters, occurring within a 180-day period, with any of the defining diagnoses of menorrhagia (see ICD9 and ICD10 code lists below) in any diagnostic position.
Incidence rules:
For individuals who meet the case definition:
The incidence date is considered the date of the first hospitalization or outpatient medical encounter that includes a defining diagnosis of menorrhagia.
An individual is considered a new incident case if at least 365 days have passed between medical encounters with a case defining diagnosis of menorrhagia (see explanation of “gap” rule below)..
Exclusions:
None
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MENORRHAGIA
Background
This case definition was developed by the Armed Forces Health Surveillance Center (AFHSC) for the purpose of epidemiological surveillance of a condition important to military-associated populations.
Clinical Description
Menorrhagia, or heavy menstrual bleeding, is defined clinically as excessive bleeding (greater than 80 milliliters per period, often with large blood clots) that occurs during menstrual periods that last seven days or longer over several consecutive monthly cycles. Such periods often interfere with work and activities of daily living and, if left untreated, can lead to iron deficiency anemia. The condition is most common among women of reproductive age, especially those approaching menopause. Common etiologies include hormonal disorders, bleeding disorders, uterine polyps, and uterine fibroids. Treatment depends upon the underlying cause of the bleeding and, as appropriate, the woman’s desire to preserve fertility.^1 ,^2
(^1) Dorsey, K.S. Armed Forces Health Surveillance Center. Menorrhagia, Active Component Service
Women, U.S. Armed Forces, 1998-2012. Medical Surveillance Monthly Report (MSMR). 2013; 20(9): 20-24. (^2) Treatment of Menorrhagia. American Family Physician. 2007 Jun 15; 75(12): 1813-1819.
AFHSC Surveillance Case Definitions
Codes
The following ICD9 codes are included in the case definition:
Condition ICD-10-CM Codes ICD-9-CM Codes
Menorrhagia N92.0 (excessive and frequent menstruation with regular cycle)
626.2 (excessive or frequent menstruation; includes heavy periods, menometrorrhagia, menorrhagia, and polymenorrhea)
N92.2 (excessive menstruation at puberty) 626.3 (puberty bleeding; excessive bleeding associated with onset of menstrual periods; pubertal menorrhagia)
N92.4 (excessive bleeding in the premenopausal period)
627.0 (premenopausal menorrhagia)
Development and Revisions
In January of 2015 the case definition was updated to include ICD10 codes.
This case definition was developed in September of 2013 by Armed Forces Health Surveillance Center staff for use in a MSMR article on menorrhagia. The definition was developed based on reviews of the ICD9 codes, the scientific literature, and previous AFHSC analyses.
Case Definition and Incidence Rule Rationale
This case definition uses a 365-day “gap in care” incidence rule to define a new incident case of menorrhagia. Use of this methodology presumes that medical encounters for menorrhagia that occur within 365 days of a previous such encounter constitute follow-up care of the previously diagnosed case. The goal of the “gap in care” rule is to lessen the frequency with which encounters for follow-up care are treated as new incident cases of the condition.^3 The “gap in care” rule differs slightly from an absolute 365 - day incidence rule in which an individual may be considered an incident case once every 365 days.
A period of 365 days between encounters is used to allow for adequate treatment and resolution of a case of menorrhagia and to avoid confusing medical encounters for follow-up care with medical encounters for a new case. Denominators for rates were calculated by summing the person-time in military service for all female active component service members who served during the surveillance period. For denominator calculations for the 2013 MSMR on menorrhagia, females with a history of prior hysterectomy were not excluded. Investigators may wish to remove these women for future analyses.
(^3) Detailed information on this analysis is available through the Armed Forces Health Surveillance
Center; reference Defense Medical Surveillance System (DMSS) Request #58558 (Menorrhagia, Final, Active Component U.S. Armed Forces, 2002-2011), 2012.
