Heavy Menstrual Bleeding Flashcards
What is heavy menstrual bleeding (HMB)?
heavy menstrual bleeding, also known as menorrhagia, is excessive menstrual blood loss that interferes with a woman’s physical, social, or emotional quality of life.
What is the typical volume of blood loss in heavy menstrual bleeding?
heavy menstrual bleeding is defined as blood loss >80 ml per cycle, but it is often diagnosed based on the woman’s subjective experience.
What are the common causes of heavy menstrual bleeding?
Causes include fibroids, adenomyosis, endometrial polyps, endometrial hyperplasia, hormonal imbalances, and coagulopathies.
What are the structural causes of heavy menstrual bleeding?
Structural causes include fibroids, adenomyosis, and endometrial polyps.
What are the non-structural causes of heavy menstrual bleeding?
Non-structural causes include hormonal imbalance, hypothyroidism, coagulopathies, and medications like anticoagulants or IUDs.
What are the risk factors for heavy menstrual bleeding?
Risk factors include obesity, polycystic ovary syndrome (PCOS), use of anticoagulants, and family history of coagulopathies.
What are the symptoms associated with heavy menstrual bleeding?
Symptoms include heavy bleeding during periods, passage of large clots, prolonged menstrual bleeding, and fatigue from anaemia.
What investigations are performed for heavy menstrual bleeding?
Investigations include full blood count (FBC), iron studies, thyroid function tests, pelvic ultrasound, and hysteroscopy if needed.
What is the role of pelvic ultrasound in heavy menstrual bleeding?
Pelvic ultrasound assesses the uterus and ovaries for structural abnormalities such as fibroids, adenomyosis, or endometrial polyps.
What is the significance of endometrial biopsy in heavy menstrual bleeding?
Endometrial biopsy is used to exclude endometrial hyperplasia or cancer, especially in women over 45 or with risk factors for malignancy.
How is coagulopathy as a cause of heavy menstrual bleeding investigated?
Coagulopathy is investigated with tests such as PT, aPTT, fibrinogen, and screening for von Willebrand disease.
What is the first-line medical treatment for heavy menstrual bleeding?
First-line treatment includes levonorgestrel-releasing intrauterine system (LNG-IUS), such as Mirena.
What other medical therapies are used for heavy menstrual bleeding?
Options include tranexamic acid, NSAIDs, combined oral contraceptives, oral progestogens, or gonadotropin-releasing hormone agonists.
How does tranexamic acid work in heavy menstrual bleeding?
Tranexamic acid reduces menstrual blood loss by inhibiting fibrinolysis in the endometrium.
What surgical options are available for heavy menstrual bleeding?
Surgical options include endometrial ablation, myomectomy, uterine artery embolisation, and hysterectomy for severe or refractory cases.
What is endometrial ablation?
Endometrial ablation is a minimally invasive procedure to destroy the endometrial lining, reducing or stopping menstrual bleeding.
When is hysterectomy indicated for heavy menstrual bleeding?
Hysterectomy is indicated in cases of severe heavy menstrual bleeding unresponsive to other treatments or when there is a risk of malignancy.
What is adenomyosis, and how does it contribute to heavy menstrual bleeding?
Adenomyosis occurs when endometrial tissue grows into the uterine muscle, causing heavy, painful periods.
How do fibroids cause heavy menstrual bleeding?
Fibroids, especially submucosal ones, distort the uterine cavity, increasing surface area and disrupting normal endometrial shedding.
What lifestyle changes can help manage heavy menstrual bleeding?
Lifestyle changes include maintaining a healthy weight, reducing stress, and optimising iron intake through diet or supplements.
How is anaemia managed in women with heavy menstrual bleeding?
Anaemia is managed with iron supplementation, dietary changes, and, in severe cases, blood transfusion.
What is the prognosis for women with heavy menstrual bleeding?
With appropriate treatment, most women experience significant improvement in symptoms and quality of life.
How does PCOS contribute to heavy menstrual bleeding?
PCOS causes irregular ovulation, leading to thickened endometrium and heavier bleeding when menstruation occurs.
What psychological impacts can heavy menstrual bleeding have on women?
heavy menstrual bleeding can lead to anxiety, depression, reduced self-esteem, and impaired quality of life.
What are the contraindications for LNG-IUS in heavy menstrual bleeding?
Contraindications include pelvic infection, uterine abnormalities, or suspected endometrial cancer.
What role does combined oral contraceptives play in heavy menstrual bleeding management?
Combined oral contraceptives regulate menstrual cycles, reduce blood loss, and provide contraception.
