Managing Heavy Menstrual Bleeding. By Dr. Rebecca Cox & Dr. Nabeela Hasan. Aims & Objectives. Defining heavy menstrual bleeding Why is it important Causes Case Scenarios Familiarise new NICE guidelines. What is heavy menstrual bleeding?.
Dr. Rebecca Cox
Dr. Nabeela Hasan
Heavy menstrual bleeding (HMB) can be defined as excessive menstrual blood loss which interferes with a woman’s physical, social, emotional and/or material quality of life.
(NICE guidelines for Heavy Menstrual Bleeding : January 2007)
(www.doctorsnet.uk- menorrhagia module 2004/5)
Malignant: Endometrial Ca
Systemic: thyroid disease
coagulation disordersCauses For HMB & Erratic Bleeding
- Has to change tampon and pad every 2-3 hrs
- has flooded several times and is always worried about this.
- Bleeds heavily for 4 days.
1. Levonorgestrel-releasing intrauterine system.
2. Tranexamic Acid, NSAIDs or COCPs..
3. Oral progestogen (northisterone) or Injected progestogen.
- This can be offered to women with small fibroids <3cm diameter
- for women who want to preserve uterus and avoid surgery. May remain fertile.
- for women who want to preserve uterus.
May remain fertile.
- if other treatments fail, if the women no longer wishes to retain her uterus or fertility
- if she has been fully informed
- if she wishes to have amenorrhoea