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Heavy Menstual Bleeding - PowerPoint PPT Presentation


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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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Presentation Transcript
definition
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
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
Management
  • History
    • Menstrual cycle
    • PMB
    • IMB
    • Vaginal discharge
    • Previous Gynae problems
    • Pregnancy history
management5
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
management6
Management
  • Consider endometrial biopsy for
    • Persistent intermenstrual bleeding
    • Women > 45
    • Treatment failure
    • Ineffective treatment
management7
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
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
management9
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
slide10

If severe impact on life or fibroids > 3cm then consider

    • Hystercetomy
    • Myomectomy
    • Uterine artery ablation
management11
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
Not recommended
  • Direct or indirect menstrual blood loss measurement
  • Serum ferritin test
  • Female hormone testing
  • Thyroid testing
  • D & C
not recommended13
Not recommended
  • Oral progesterones in luteal phase only
  • Danazol
  • Etamsylate
  • D & C