Download 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
 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
Management
 History
 Menstrual cycle
 PMB
 IMB
 Vaginal discharge
 Previous Gynae problems
 Pregnancy history
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
Management
 Consider endometrial biopsy
for
 Persistent intermenstrual
bleeding
 Women > 45
 Treatment failure
 Ineffective treatment
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
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
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
 If severe impact on life or fibroids
> 3cm then consider
 Hystercetomy
 Myomectomy
 Uterine artery ablation
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
Not recommended
 Direct or indirect menstrual blood loss
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measurement
Serum ferritin test
Female hormone testing
Thyroid testing
D&C
Not recommended
 Oral progesterones in luteal phase only
 Danazol
 Etamsylate
 D&C