Heavy Menstual Bleeding
Download
Report
Transcript 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
measurement
Serum ferritin test
Female hormone testing
Thyroid testing
D&C
Not recommended
Oral progesterones in luteal phase only
Danazol
Etamsylate
D&C