Heavy menstrual bleeding (HMB)

Question 1

What is heavy menstrual bleeding

Answer 1

Blood loss that interferes with physical, social, emotional, or material aspect of a woman’s life

Question 2

What are some causes of heavy menstrual bleeding?

Answer 2

Fibroids
Polyps
Adenomyosis
Coagulopathy
Malignancy

Question 3

What is the most common cause of heavy menstrual bleeding?

Answer 3

fibroids (20-30%)

Question 4

What is the most common coagulopathy causing heavy menstrual bleeding

Answer 4

Von Willebrand disease

Question 5

What are some risk factors for heavy menstrual bleeding?

Answer 5

Age (Menarche and menopause)
Obesity
Cause specific risk factors

Question 6

What are some symptoms of heavy menstrual bleeding?

Answer 6

• Bleeding during menstruation deemed to be excessive for the individual woman
• Fatigue
• Shortness of breath (if associated anaemia)

Question 7

What are some signs of heavy menstrual bleeding?

Answer 7

• Pallor (anaemia)
• Palpable uterus or pelvic mass
  
  • Try to ascertain if the uterus is smooth or irregular (fibroids)
  • A tender uterus or cervical excitation point toward adenomyosis/endometriosis
• Inflamed cervix/cervical polyp/cervical tumour
• Vaginal tumour

Question 8

What are some possible investigations in heavy menstrual bleeding?

Answer 8

Exclude pregnancy
Bloods - FBC, coag screen
Cervical smear, infection swabs
Trans-vaginal US
pipette endometrial biopsy
Hysteroscopy

Question 9

1st line management of heavy menstrual bleeding

Answer 9

Mirena coil

Question 10

2nd line management of heavy menstrual bleeding

Answer 10

Transexamic acid or COC (Depends on fertility needs)

Question 11

3rd and 4th line management of heavy menstrual bleeding

Answer 11

POP
Surgery, depot or implant