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?.
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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