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Heavy Menstual Bleeding

2007. Heavy Menstual Bleeding. Definition. Excessive menstrual blood loss which interferes with a woman’s physical, emotional, social and material quality of life, and which can occur alone or in combination with other symptoms . Surgery.

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Heavy Menstual Bleeding

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  1. 2007 Heavy Menstual Bleeding

  2. Definition • Excessive menstrual blood loss which interferes with a woman’s physical, emotional, social and material quality of life, and which can occur alone or in combination with other symptoms.

  3. Surgery • With HMB alone and uterus no bigger than 10/52 pregnant • Endometrial ablation rather than hysterectomy • If hysterectomy essential then • First line vaginal hysterectomy • Second line abdominal hysterectomy

  4. Management • History • Menstrual cycle • PMB • IMB • Vaginal discharge • Previous Gynae problems • Pregnancy history

  5. Management • Examination • Abdominal exam • Pelvic exam if appropriate • Swabs if discharge • Fbc (not in nice guidelines) • Arrange imaging if • Second line drug treatment fails • Uterus is palpable abdominally or on PV

  6. Management • Consider endometrial biopsy for • Persistent intermenstrual bleeding • Women > 45 • Treatment failure • Ineffective treatment

  7. Management • No structural abnormality • First line drug therapy • If fails • Second line drug therapy • Consider imaging - ultrasound • HMB + structural uterine abnormality i.e. Palpable uterus • Arrange imaging

  8. Treatment • If history and investigations indicate that drug treatment is appropriate, drugs should be tried in the following order • MIRENA • Tranexamic acid, COC, NSAIDS • Norethisterone 15mg/day from day 5-26 of cycle or injection of long acting progesterones

  9. Management • If drug therapy fails and severe impact on life + no desire to conceive + normal uterus or small fibroids < 3cm then • Endometrial ablation or • Hysterectomy

  10. If severe impact on life or fibroids > 3cm then consider • Hystercetomy • Myomectomy • Uterine artery ablation

  11. Management • If other • treatments have failed or are contraindicated or declined • Desire for amenorrhoea • Fully informed women requests it • No desire to retain uterus and fertility • Hysterectomy but don’t remove healthy ovaries

  12. Not recommended • Direct or indirect menstrual blood loss measurement • Serum ferritin test • Female hormone testing • Thyroid testing • D & C

  13. Not recommended • Oral progesterones in luteal phase only • Danazol • Etamsylate • D & C

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