Heavy Menstrual Bleeding
Definition
“excessive menstrual blood loss interfering
with the woman's physical, emotional,
social and material quality of life, and
which occurs alone or in combination with
other symptoms”
Ms. JA
• 40yr
• Bit embarrassed
• Heavy periods
What should I do next?
HISTORY
• What does she mean by
heavy periods?
• Duration?
• Regular/irregular?
• LMP?
• Painful? PCB? IMB?
• Dysparenunia?
• PV discharges
• Obstetric?
• Menarche/Climacteric?
• Medications?
• Other bleeding problems?
• Secondary pathologies?
And then?
Examination
• Pulse
• BP
• Abdominal
examination
• Gynaecological
examination
• FBC
– ± C Smear
• Anaemia
NORMAL
How do I group problems?
N.I.C.E.
NON
STRUCTURAL
STRUCTURAL
Non Structural?
• Physiological
• Medication
• Psychological?
Pharmacological Approach
What do they mean?
1st line
IUS
2nd line
Tranexamic acid
NSIAD
COC
3rd line
Oral progesterone
(Northisterone)
Injected progesterone
Others – GnRH Analogues
Ms. HB
• 40yr Afro-Caribbean
• Embarrassing problem
• Bleeding
So what should I do next?
HISTORY
+
EXAMINATION
Abnormal
(Enlarged uterus)
Now what?
STRUCTURAL
Fibriods<3cm/
Pharmacology
failure
Enlarged uterus
>45,
Persistent IMB,
or treatment failure
USS 1st line
Endometrial bx
Assume nothing sinister…
Very Severe
+
No plans to conceive/
small fibroids <3cm
ENDOMETRIAL ABLATION
HYSTERECTOMY
What if…
Very Severe
+
Fibroids>3cm
MYOMECTOMY, U.A. EMBOLISATION,
HYSTERECTOMY
Moral of the story…
WHEN ALL
ELSE FAILS…
REMOVE IT??
• Consider
–
–
–
–
Impact on sexual feeling
Other options/subtotal methods
GnRH analogues
Impact on future wellbeing/fertility