Heavy Menstrual Bleeding

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Heavy Menstrual Bleeding
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Definition

• excessive menstrual blood loss interfering with
  the woman's physical, emotional, social and
  material quality of life, and which occurs alone
  or in combination with other symptoms

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Ms. JA

• 40yr
• Bit embarrassed
• Heavy periods

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What should I do next?
HISTORY

• What does she mean by heavy periods?
• Duration?
• Regular/irregular?
• LMP?
• Painful? PCB? IMB?
• Dysparenunia?
• PV discharges
• Obstetric?
• Menarche/Climacteric?

• Medications?
• Other bleeding problems?
• Secondary pathologies?

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And then?
Examination

• Pulse
• BP
• Abdominal examination
• Gynaecological examination
• C Smear
• Anaemia

• FBC

NORMAL
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How do I group problems?
N.I.C.E.
NON STRUCTURAL
STRUCTURAL
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Non Structural?

• Physiological
• Medication
• Psychological?

Pharmacological Approach
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What do they mean?
1st line IUS
3rd line Oral progesterone (Northisterone) Inject
ed progesterone
2nd line Tranexamic acid NSIAD COC
Others GnRH Analogues
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Ms. HB

• 40yr Afro-Caribbean
• Embarrassing problem
• Bleeding

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So what should I do next?
HISTORY

EXAMINATION
Abnormal
(Enlarged uterus)
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Now what?
STRUCTURAL
Fibriodslt3cm/ Pharmacology failure
gt45, Persistent IMB, or treatment
failure Endometrial bx
Enlarged uterus
USS 1st line
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Assume nothing sinister
Very Severe

No plans to conceive/ small fibroids lt3cm
ENDOMETRIAL ABLATION
HYSTERECTOMY
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What if
Very Severe

Fibroidsgt3cm
MYOMECTOMY, U.A. EMBOLISATION, HYSTERECTOMY
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Moral of the story
WHEN ALL ELSE FAILS REMOVE IT??

• Consider
• Impact on sexual feeling
• Other options/subtotal methods
• GnRH analogues
• Impact on future wellbeing/fertility

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