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Heavy Menstrual Bleeding

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.

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Heavy Menstrual Bleeding

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  1. Heavy Menstrual Bleeding

  2. 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”

  3. Ms. JA • 40yr • Bit embarrassed • Heavy periods

  4. 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? What should I do next? HISTORY

  5. Pulse BP Abdominal examination Gynaecological examination ± C Smear Anaemia FBC And then? Examination NORMAL

  6. How do I group problems? N.I.C.E. NON STRUCTURAL STRUCTURAL

  7. Non Structural? • Physiological • Medication • Psychological? Pharmacological Approach

  8. What do they mean? 1st line IUS 3rd line Oral progesterone (Northisterone) Injected progesterone 2nd line Tranexamic acid NSIAD COC Others – GnRH Analogues

  9. Ms. HB • 40yr Afro-Caribbean • Embarrassing problem • Bleeding

  10. So what should I do next? HISTORY + EXAMINATION Abnormal (Enlarged uterus)

  11. Now what? STRUCTURAL Fibriods<3cm/ Pharmacology failure >45, Persistent IMB, or treatment failure Endometrial bx Enlarged uterus USS 1st line

  12. Assume nothing sinister… Very Severe + No plans to conceive/ small fibroids <3cm ENDOMETRIAL ABLATION HYSTERECTOMY

  13. What if… Very Severe + Fibroids>3cm MYOMECTOMY, U.A. EMBOLISATION, HYSTERECTOMY

  14. Consider Impact on sexual feeling Other options/subtotal methods GnRH analogues Impact on future wellbeing/fertility Moral of the story… WHEN ALL ELSE FAILS… REMOVE IT??

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