Heavy menstrual bleeding (HMB) - AUD Lecture

Question 1

What is HMB

Answer 1

when bleeding is >80ml or lasting >7 days

Question 2

Pathophysiology

Answer 2

MUST FIRST RULE OUT: pregnancy, ectopic pregnancy, miscarriage
Hematologic - bleeding/ clotting disorders
Hepatic- cirrhosis (scarring of liver)
Endocrine - hypothyroidism
Uterine - structural abnormalities, uterine fibroids

Question 3

Symptoms

Answer 3

Heavy blood flow with menstruation, with or without pain
possibly : fatigue and lightheadedness

Question 4

Treatment for Chronic management

Answer 4

Hormonal - CHC, Progestins, levonorgestrel IUD, Danazol, GnRH agonist
Nonhormonal - NSAIDS, Tranexamic acid, Iron

Question 5

Tranexamic acid (treatment of chronic HMB)

Answer 5

• MOA - antifibrinolytic - prevents the degradation of blood clots
• dosing 1,300mg PO TID for 5 days
• short term use only (during period)
  SE: generally well tolerated but can cause HA, nasal symptoms

Question 6

Treatment for acute HMB

Answer 6

Perferred agent - High dose estrogen (conjugated equine estrogen or monophasic OC)
If contraindications to estrogen therapy then- nedroxyprogesterone 20mg PO TID for 7 days
If contraindications to hormone therapy - tranexamic acid 1,300mg PO TID for 5 days