Materiały źródłowe

• #1 Diagnosis of Heavy Menstrual Bleeding

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5779565/

  Heavy menstrual bleeding (HMB) is an important health problem. This paper gives an overview of the diagnosis of HMB. For each woman, a thorough history should be taken as one should ascertain whether there are underlying factors that could cause complaints of HMB. Objectively knowing whether or not the blood loss is excessive could also be very beneficial. The pictorial blood assessment chart score can help with diagnosis. Physical examination starts with standard gynecological examination. Imaging tests are widely used in the work-up for women with HMB. The first step in imaging tests should be the transvaginal ultrasound. Other diagnostic tests should only be performed when indicated. […] HMB can be caused by abnormal blood clotting, disruption of normal hormonal regulation or uterine pathology (e.g., fibroids, polyps, adenomyosis). It is important to diagnose the underlying cause in order to determine the best treatment option.

• #1 About Heavy Menstrual Bleeding | Bleeding Disorders in Women | CDC

  https://www.cdc.gov/female-blood-disorders/about/heavy-menstrual-bleeding.html

  Periods that last for more than 7 days are considered heavy. […] Periods that require a new tampon or pad after less than 2 hours or involve passing large clots are considered heavy. […] Your healthcare provider can determine if you might need testing for a possible bleeding disorder. […] Finding out if a woman has heavy menstrual bleeding often is not easy, because each person might think of „heavy bleeding” in a different way. […] If you have bleeding that lasts longer than 7 days per period or is so heavy that you have to change your pad or tampon nearly every hour, you need to talk with your healthcare provider. […] To find out if you have heavy menstrual bleeding, your healthcare provider will ask you about your medical history and menstrual cycles. […] Your healthcare provider may also ask if any of your family members have had heavy menstrual bleeding.

• #1 Heavy periods

  https://www.nhs.uk/conditions/heavy-periods/

  Many women have heavy periods (also called menorrhagia) and they may be normal for you. Treatment can help if they’re affecting your daily life. […] You may have heavy periods if you: need to change your pad or tampon every 1 to 2 hours, or empty your menstrual cup more often than is recommended; need to use 2 types of period product together, such as a pad and a tampon; have periods lasting more than 7 days; pass blood clots larger than about 2.5cm (the size of a 10p coin); bleed through to your clothes or bedding; avoid daily activities, like exercise, or take time off work because of your periods; feel tired or short of breath a lot. […] Sometimes heavy periods can be caused by: conditions affecting your womb or ovaries, such as polycystic ovary syndrome, fibroids, endometriosis, adenomyosis and pelvic inflammatory disease; conditions that can make you bleed more easily, such as Von Willebrand disease; some medicines and treatments, including some anticoagulant medicines and chemotherapy medicines.

• #1 Heavy menstrual bleeding – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/menorrhagia/symptoms-causes/syc-20352829

  Some women have menstrual bleeding that is heavy or lasts for more than a few days. This condition used to be called menorrhagia. Heavy menstrual bleeding is a common concern. But most women don’t have enough blood loss for it to be called heavy menstrual bleeding. […] With heavy menstrual bleeding, blood flow and cramping make it harder to do your usual activities. If you dread your period because you have heavy menstrual bleeding, talk with your doctor. There are many treatments that can help. […] Symptoms of heavy menstrual bleeding may include: Soaking through one or more sanitary pads or tampons every hour for several hours in a row. Needing double sanitary protection to control your menstrual flow. Getting up at night to change sanitary pads or tampons. Bleeding for more than a week. Passing blood clots larger than a quarter. Limiting daily activities due to heavy menstrual flow. Feeling tired, fatigued or short of breath as the result of blood loss.

• #1 Heavy menstrual bleeding: work-up and management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6142441/

  Heavy menstrual bleeding (HMB), which is the preferred term for menorrhagia, affects 90% of women with an underlying bleeding disorder and 70% of women on anticoagulation. HMB can be predicted on the basis of clots of 1 inch diameter, low ferritin, and flooding (a change of pad or tampon more frequently than hourly). The goal of the work-up is to determine whether there is a uterine/endometrial cause, a disorder of ovulation, or a disorder of coagulation. […] HMB manifest by flooding and/or prolonged menses, or HMB accompanied by a personal or family history of bleeding is very suggestive of a bleeding disorder and should prompt a referral to a hematologist. The evaluation will include the patients history, pelvic examination, and/or pelvic imaging, and a laboratory assessment for anemia, ovulatory dysfunction, underlying bleeding disorder, and in the case of the patient on anticoagulation, assessment for over anticoagulation.

• #1 Heavy Menstrual Bleeding: The Rough Road from Diagnosis to Treatment – Uterine Fibroids: Contemporary Approaches

  https://www.medpagetoday.com/resource-centers/uterine-fibroids-contemporary-approaches/heavy-menstrual-bleeding-rough-road-diagnosis-treatment/3370

  Heavy menstrual bleeding (HMB) is excessive blood loss during the menstrual cycle that affects a woman’s quality of life. […] With no clinical care pathway established for HMB, researchers sought to understand the typical diagnostic and treatment journey of women with HMB. […] Respondents of a heavy menstrual bleeding (HMB) survey revealed major challenges in their quest for diagnosis and treatment, with only 20% receiving a diagnosis and treatment for the condition. […] Patients’ and providers’ lack of information on HMB played a central role in preventing swift diagnosis and appropriate treatment. […] To minimize diagnostic delays, health care providers should assess subjective symptoms (impact of heavy bleeding on quality of life) as opposed to quantity of bleeding. […] For many women, the journey from onset of symptoms through diagnosis to treatment of HMB is long and characterized by barriers, delays, misdiagnoses, and missed opportunities for effective treatment with the majority of women remaining undiagnosed and untreated.

• #1 Heavy menstrual bleeding – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/menorrhagia/diagnosis-treatment/drc-20352834

  During hysterosonography (his-tur-o-suh-NOG-ruh-fee), you have a thin, flexible tube called a catheter placed in the uterus. Salt water, also called saline, is injected through the flexible tube into the hollow part of the uterus. An ultrasound probe transmits images of the inside of the uterus to a nearby monitor. […] During hysteroscopy (his-tur-OS-kuh-pee), a thin, lighted instrument provides a view of the inside of the uterus. This instrument also is called a hysteroscope. […] A member of your health care team will likely ask about your medical history and menstrual cycles. You may be asked to keep a diary to track days with and without bleeding. Record information such as how heavy your flow was and how many sanitary pads or tampons you needed to control it. […] After doing a physical exam, your doctor or other member of your care team may recommend certain tests or procedures. They may include:

• #1 Heavy menstrual bleeding: diagnosis and management options – The Pharmaceutical Journal

  https://pharmaceutical-journal.com/article/ld/heavy-menstrual-bleeding-diagnosis-and-management-options

  Heavy menstrual bleeding has a major impact on a woman’s quality of life. This article covers the most recent guidance and treatment options available. Menorrhagia, also known as heavy menstrual bleeding (HMB), is widely accepted as the loss of menstrual blood of ≥60–80ml per cycle, compared with 30–40ml for the average woman with ‘normal’ periods. Women with HMB may describe having to use both tampons and sanitary towels, having to frequently change sanitary towels, and/or the presence of large menstrual clots. The National Institute for Health and Care Excellence (NICE) defines HMB more holistically as “excessive blood loss that interferes with the woman’s physical, emotional, social and material quality of life.” […] Obtaining a detailed history from the patient is the best way to diagnose HMB, with physical examinations and tests performed to exclude more serious conditions. History-taking should include questions on the nature of the bleeding, the patient’s perspective on whether this variation falls within normal fluctuations in their cycle and blood loss, and how it is affecting their quality of life, as well as questions on their medical history. Women aged 55 years and over who have post-menopausal bleeding should be referred using a suspected cancer pathway referral for an appointment within two weeks as per NICE guidelines.

• #1 Heavy Menstrual Bleeding | ACOG

  https://www.acog.org/womens-health/faqs/heavy-menstrual-bleeding

  Many things can cause heavy menstrual bleeding. Some of the causes include the following: Fibroids and polyps, Adenomyosis, Irregular ovulation, Bleeding disorders, Medications, Cancer, Other causes. […] When you see your ob-gyn about heavy menstrual bleeding, you may be asked about past and present illnesses and surgical procedures, pregnancy history, medications, including those you buy over the counter, your birth control method, your menstrual cycle. […] You may have a physical exam, including a pelvic exam. Several lab tests may be done. You may have a pregnancy test and tests for some sexually transmitted infections (STIs). […] Medications often are tried first to treat heavy menstrual bleeding: Heavy bleeding caused by problems with ovulation, endometriosis, PCOS, and fibroids often can be managed with certain hormonal birth control methods.

• #1 Heavy Menstrual Bleeding Diagnosis and Treatment Options – Prof. Dr. Basak Baksu

  https://basakbaksu.com.tr/en/yogun-adet-kanamasi-tanisi/

  Heavy menstrual bleeding reduces a woman’s physical endurance over time. Weakness, dizziness and fatigue complaints increase. Some patients may also develop psychological effects such as depression and anxiety. These symptoms can cause a decrease in performance in the individual’s work and social life. Women have to take this into account when planning their daily lives. Therefore, menorrhagia diagnosis is not just a medical finding; it is an important factor that determines the standard of living. […] Menorrhagia Diagnostic Methods […] The first step in diagnosing menorrhagia is a careful and systematic examination. The gynecologist listens to the patient’s detailed medical history. The menstrual cycle, duration and amount of bleeding are carefully noted. In addition, accompanying symptoms are questioned. Symptoms such as pain, weakness and dizziness provide important clues to the diagnosis. The doctor obtains information about previous pregnancies, medications used and similar conditions in the family. This process helps to determine possible causes.

• #1 Diagnosis of Heavy Menstrual Bleeding

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5779565/

  Although a large amount of blood loss is the main reason to consult a general practitioner or gynecologist, women’s perception of the severity of bleeding does not often correlate with the objective amount of blood loss. Only 4050% of women with complaints of HMB exceed 80 ml blood loss. Knowing whether or not the woman is suffering from HMB can be very beneficial for both patient and clinician; evaluating the actual amount of blood loss means that many women could be reassured that their blood loss is not excessive. […] Therefore, evaluating the blood loss is the first step toward diagnosing HMB. […] Higham et al. developed a subjective method to determine whether or not women meet the diagnosis of HMB: the pictorial blood assessment chart (PBAC). The self assessed PBAC consists of diagrams representing different soiled towels and tampons. Women are instructed to count their number of used towels or tampons each day and then divide them by level of soiling. The chart is scored using the scoring system devised by Higham et al. This measurement method has a specificity and sensitivity of 8090%.

• #1 Heavy Periods (Menorrhagia): Causes and Treatment

  https://patient.info/womens-health/periods-and-period-problems/heavy-periods-menorrhagia

  A doctor may want to do an internal (vaginal) examination to examine the neck of the womb (cervix) and also to assess the size and shape of the womb. However, an examination is not always necessary, especially in younger women who do not have any symptoms to suggest anything other than dysfunctional uterine bleeding. A blood test to check for anaemia may be performed. Women who bleed heavily each month may not take in enough iron in their diet to replace the blood that they lose. […] If there is an underlying cause, such as a fibroid or endometriosis, treatment options may be different. […] Treatment will depend on the cause – as mentioned above, often no cause is found. However, there are still treatments that can make periods lighter. The benefits and the possible side-effects will be discussed before deciding which to use.

• #1 Heavy Menstrual Bleeding Diagnosis and Treatment Options – Prof. Dr. Basak Baksu

  https://basakbaksu.com.tr/en/yogun-adet-kanamasi-tanisi/

  The doctor then performs a physical examination. A manual examination of the lower abdomen reveals conditions such as uterine size or tenderness. The structure of the uterus and ovaries is evaluated during the pelvic examination. If there is a visible abnormality, imaging methods are used. These findings determine the direction of the tests to be performed in the following stages. […] One of the most commonly used methods in the diagnosis process is ultrasonography. Gynecological ultrasound shows the inner layer of the uterus and muscle tissue in detail. Myoma, polyp or thickened endometrium are easily detected with this method. Ultrasound performed vaginally increases image quality and provides clearer results. […] Blood tests are important in the diagnosis of menorrhagia. A blood count, especially for anemia, reveals the degree of blood loss. If hemoglobin levels are low, this may indicate severe iron deficiency. In addition, hormonal and systemic causes should be investigated.

• #1 Menorrhagia Workup: Laboratory Studies, Imaging Studies, Procedures

  https://emedicine.medscape.com/article/255540-workup

  The CBC count may be used to evaluate hemoglobin and hematocrit and determine severity of anemia, if present. Use the platelet count in conjunction with a peripheral smear if a coagulation defect is suspected. An elevated white blood cell count can be followed in treatment of infectious processes. […] These studies are used to rule out von Willebrand disease; ITP; and factor II, V, VII, or IX deficiency. These tests should be ordered sparingly because they are expensive tests for rare disorders (usually in the adolescent age group). […] Pregnancy remains the most common cause of abnormal uterine bleeding in patients of reproductive age. Bleeding can denote threatened abortion, incomplete abortion, ectopic pregnancy, or in rare cases, gestational trophoblastic disease. […] These tests can rule out hyperthyroidism, hypothyroidism, and hyperprolactinemia. All of these conditions can cause ovarian dysfunction leading to possible menorrhagia.

• #1 Menorrhagia: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/255540-overview

  Laboratory studies that may be useful include the following: Complete blood cell count, Iron studies (eg, total iron-binding capacity [TIBC] and total iron), Thyroid function tests and prolactin level, Liver function tests (LFTs) and renal function tests (eg, blood urea nitrogen [BUN] and creatinine), Hormone assays (eg, luteinizing hormone [LH], follicle-stimulating hormone [FSH], and androgen) for suspected polycystic ovary syndrome (PCOS); adrenal function tests for suspected adrenal tumors, Coagulation factor studies (expensive and to be used sparingly). […] Imaging studies and other diagnostic measures that may be helpful include the following: Pelvic ultrasonography, Sonohysterography (saline-infusion sonography), Cervical specimens (eg, Pap smear, sexually transmitted infection [STI] testing), Endometrial biopsy (EMB), Hysteroscopy.

• #1 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Diagnosis-of-Menorrhagia.aspx

  Other diagnosis should be considered. […] The work up for Menorrhagia includes complete and routine blood tests. […] A low haemoglobin signifies anemia due to excessive blood loss. […] Iron assessments in blood may also help detect anemia. […] Increased White Blood Cell count may signify pelvic inflammations. […] Platelet count and assessment of coagulation of blood may help detect bleeding disorders. […] Thyroid function tests and prolactin level helps detect problems of the thyroid gland and pituitary gland that may be causing menstrual abnormalities. […] Liver function and kidney function tests are used to detect underlying liver or kidney disorders. […] Pregnancy should be excluded by routine pregnancy tests. […] Hormone assays like assessment of LH (luteinizing hormone), FSH (follicle stimulating hormone), estrogen and progestrones are done to exclude hormonal disorders.

• #1 Menorrhagia Workup: Laboratory Studies, Imaging Studies, Procedures

  https://emedicine.medscape.com/article/255540-workup

  Order liver function tests (LFTs) when liver disease is suspected, such as in persons with alcoholism or hepatitis. BUN and creatinine tests assess renal function. Dysfunction of either organ can alter coagulation factors and/or the metabolism of hormones. […] Total testosterone and sex hormone-binding globulin or free testosterone can assist in diagnosing biochemical hyperandrogenemia in those with suspected PCOS. […] This procedure is used in women who are at risk for endometrial polyps, hyperplasia, or carcinoma, though other pathology may be found. Endometrial sampling should be a first-line test in those with menorrhagia who are older than 45 years and those younger than 45 years with a history of exposure to unopposed estrogen, persistent menorrhagia, and/or failed medical management.

• #1 Menorrhagia –Diagnosis and Treatment : Emergency Care BC

  https://emergencycarebc.ca/clinical_resource/clinical-summary/menorrhagia-diagnosis-and-treatment/

  Menorrhagia, or prolonged or excessive uterine bleeding, can have a significant impact on quality of life. […] ~1 in 20 women between 30-49 years of age will present with heavy menstruation each year. […] Heavy bleeding (>80cc of blood loss/cycle – hard to quantify clinically). […] Some patients may have anemia, fatigue, and weakness. […] Anovulatory cycles are a common cause of menorrhagia: More common at menarche and menopause and with PCOS and obesity. […] Symptoms classically include: hx of irregular periods, late period, and/or mid-cycle spotting. […] Heavy bleeding from menarche / family history of bleeding disorders: INR, PTT, Fibrinogen, von Willebrand factor antigen, Factor VIII. […] Endometrial Biopsy Indications: >40 yrs of age. […] Failure of medical treatment. […] Woman of any age with past anovulatory cycles—patient describes irregular or infrequent periods on hx. […] Menorrhagia may present with significant anemia and require emergent care. […] Progestin (medroxyprogesterone) is the most frequently prescribed medicine for menorrhagia (especially anovulatory). […] Hysterectomy = definitive treatment for abnormal uterine bleeding.

• #1 Menorrhagia: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/255540-overview

  Menorrhagia (heavy vaginal bleeding or heavy uterine bleeding) is defined as menstruation at regular cycle intervals but with excessive flow (greater than 80 cc of blood loss per cycle or requiring more frequent than 2 hour changes of hygiene products) and/or duration (longer than 7 days), or perceived as heavy bleeding by the patient. […] Symptoms related by a patient with menorrhagia often can be more revealing than laboratory tests. […] According to an international expert panel, an underlying coagulopathy or bleeding disorder should be considered when a patient has any of the following: Menorrhagia since menarche, Family history of bleeding disorders, Personal history of 1 or more of the following: (1) Notable bruising without known injury, (2) bleeding of the oral cavity or gastrointestinal tract without an obvious lesion, or (3) epistaxis of more than 10 minutes duration (possibly necessitating packing or cautery).

• #1 Diagnosis of Heavy Menstrual Bleeding

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5779565/

  In conclusion, the PBAC is a useful measure for accurately diagnosing HMB. […] The first step in imaging tests is the transvaginal ultrasound. If this is inconclusive or if intracavitary abnormalities are suspected then the physician can perform an saline infusion sonography. […] Saline infusion sonography/gel infusion sonography are reliable diagnostic procedures for excluding intracavitary abnormalities in women with HMB.

• #1 Heavy Periods – Ultrasound Scan – The Gynaecology Ultrasound Centre

  https://ultragyn.co.uk/ultrasound-scanning/heavy-periods/

  Heavy periods are common and can severely impact a women’s quality of life. […] An accurate diagnosis of the cause of menstrual problems is crucial to planning appropriate and effective treatment. Thankfully all these conditions can be diagnosed on ultrasound scans. […] This information can be used not only to determine whether the fibroids are the likely cause of women’s symptoms, but also to decide what type of treatment could be offered to women suffering with these periods. […] Using ultrasound, we can not only diagnose adenomyosis, but also see how severe it is, which correlates with the menstrual loss. This helps us determine how likely the adenomyosis is to be the cause of menstrual symptoms which helps to guide management.

• #1 Heavy Menstrual Bleeding: Symptoms and Treatment | MedPark Hospital

  https://www.medparkhospital.com/en-US/disease-and-treatment/heavy-menstrual-bleeding

  A transvaginal ultrasound to evaluate organs and tissues in your pelvic region. […] A sonohysterogram or saline-infusion sonography can assess the lining of the uterus by filling it with saline. This method can detect any intrauterine lesions more accurately than a regular ultrasound. […] An endometrial biopsy can identify cancer or abnormalities of the endometrium. […] Magnetic resonance imaging (MRI) can display abnormal structures inside the uterus. […] A hysteroscopy can inspect the vagina, cervix, and uterus for polyps, fibroids, or other abnormalities which are removable in the same sitting. […] A cervical culture can identify an infection in the uterus. […] If you experience symptoms, it is advisable to seek guidance from your gynecologist for an accurate diagnosis and effective treatment to address your condition.

• #1 Exams and Tests Used to Investigate Menstrual Disorders – Your Period

  https://www.yourperiod.ca/abnormal-pain-and-menstrual-bleeding/exams-and-tests-used-to-investigate-menstrual-disorders/

  If you have abnormal menstrual bleeding, you may require testing in order to determine the underlying problem. […] If you are experiencing abnormal menstrual bleeding, your doctor will likely recommend that you undergo some testing. […] This list of tests does not include blood tests that you might take, and is specifically referring to physical exam, imaging, radiology, and biopsies. […] MRI can be used to help diagnose many of the structural causes of heavy menstrual bleeding, such as fibroids, polyps, endometriosis, and adenomyosis. […] This procedure involves the removal of tissue from the inside of the uterus. It can be used to diagnose or treat some causes of heavy menstrual bleeding, such as fibroids, polyps, or uterine cancer.

• #1 Evaluation and Management of Abnormal Uterine Bleeding in Premenopausal Women | AAFP

  https://www.aafp.org/pubs/afp/issues/2012/0101/p35.html

  Up to 14 percent of women experience irregular or excessively heavy menstrual bleeding. This abnormal uterine bleeding generally can be divided into anovulatory and ovulatory patterns. […] Women 35 years or older with recurrent anovulation, women younger than 35 years with risk factors for endometrial cancer, and women with excessive bleeding unresponsive to medical therapy should undergo endometrial biopsy. […] Ovulatory abnormal uterine bleeding, or menorrhagia, may be caused by thyroid dysfunction, coagulation defects (most commonly von Willebrand disease), endometrial polyps, and submucosal fibroids. […] Excessive menstrual bleeding is defined as the need to change menstrual products every one to two hours, passage of clots greater than 1 inch (2.54 cm), and/or very heavy periods as reported by the patient.

• #1 Menorrhagia Workup: Laboratory Studies, Imaging Studies, Procedures

  https://emedicine.medscape.com/article/255540-workup

  EMB findings are used to assess the stage and proliferation of the endometrial stroma and glands. Many studies have been done to compare the results of EMB and dilation and curettage (DC). Both tests are accepted as equal in value and are approximately 98% accurate. […] Understanding EMB results is essential for any physician treating menorrhagia. If no tissue is returned after an EMB is performed, particularly in postmenopausal patients, most likely the endometrium is atrophic and requires estrogen. Simple proliferative endometrium is normal and does not require treatment. If sampling is insufficient or an EMB cannot be performed, a diagnostic hysteroscopy with DC can be performed. No further sampling is needed for premenopausal women if biopsy results are normal, but further evaluation should be pursued if symptoms persist or the patient is postmenopausal. […] Any biopsy that reveals endometrial hyperplasia with atypia or carcinoma should prompt immediate referral to a gynecologic oncologist for treatment outlined by current oncology protocols associated with the grade and stage of the cancer.

• #1 Patient education: Heavy periods (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/heavy-periods-beyond-the-basics

  A biopsy of the tissue inside of the uterus – This is called an endometrial biopsy. It is usually done in a doctor’s office. […] A hysteroscopy – This test uses a small scope to look inside the uterus. This may be performed in a doctor’s office or in an operating room as day surgery. […] If you have heavy menstrual bleeding, the best treatment for you will depend on: The cause of your bleeding, Your preferences, Whether you want to prevent pregnancy, Whether you might want to be able to get pregnant in the future. […] Your health care provider will probably recommend treatment with one or more medicines first. If these treatments do not reduce bleeding enough, surgical treatment might be an option. […] If you have growths in your uterus, such as polyps or fibroids, getting treatment to remove them can reduce or eliminate heavy bleeding.

• #1 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Diagnosis-of-Menorrhagia.aspx

  Imaging studies may be included to rule out organic diseases. […] A biopsy or a small amount of uterine tissue may be taken for examination under the microscope. This may be used to rule out uterus cancer. […] Papanicolaou (Pap) smear test is used to detect and rule out cervical cancers. […] Some patients may need a Dilation and curettage (DC) procedure.

• #1 Heavy Periods – Menorrhagia | Dr. Sarah Choi – Gynaecologist and Advanced Laparoscopic Surgeon in Sydney

  http://www.drsarahchoi.com.au/menorrhagia.html

  This treatment package will help you to: rule out the rare possibility of cancer on the lining of the uterus; confirm the presence/absence of polyp or fibroid inside the uterus; remove any abnormal growth inside the uterus; AND have treatment of menorrhagia at the same time. […] Part 1- Diagnosis First of all, the gynaecological surgeon performs a hysteroscopy to carefully look inside of the uterus. […] The surgeon will then obtain a biopsy at the lining of the uterus (endometrial biopsy), usually by a minor procedure called D&C. This is an important step to rule out cancer inside the uterus. […] Fibroids are one of the most common causes of heavy menstrual bleeding. […] Hysterectomy is surgical removal of uterus. It is the definitive cure of menstrual problems for women who have no desire for pregnancies in the future. […] Every women is individual and her situation requires an individual plan of management. If you think these issues relate to you, arrange a personal consultation with us to discuss your menstrual issues and know more about our treatment programmes.

• #1 Screening and Management of Bleeding Disorders in Adolescents With Heavy Menstrual Bleeding | ACOG

  https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2019/09/screening-and-management-of-bleeding-disorders-in-adolescents-with-heavy-menstrual-bleeding

  Heavy menstrual bleeding is defined as excessive menstrual blood loss that interferes with a woman’s physical, social, emotional, or material quality of life. […] Evaluation of adolescent girls who present with heavy menstrual bleeding should include assessment for anemia from blood loss, including serum ferritin, the presence of an endocrine disorder leading to anovulation, and evaluation for the presence of a bleeding disorder. […] The first-line approach to acute bleeding in the adolescent is medical management; surgery should be reserved for those who do not respond to medical therapy. […] Heavy menstrual bleeding at menarche and in adolescence may be an important sentinel for an underlying bleeding disorder. […] If obstetriciangynecologists suspect that a patient has a bleeding disorder, they should work in coordination with a hematologist for laboratory evaluation and medical management.

• #1 Adolescent gynaecology – Heavy menstrual bleeding

  https://www.rch.org.au/clinicalguide/guideline_index/adolescent_gynaecology_menorrhagia/

  The most common cause of Heavy Menstrual Bleeding (HMB) in adolescents is anovulatory cycles […] Mild bleeding with a normal haemoglobin can be managed with reassurance, non-hormonal treatments and observation […] Pregnancy related bleeding and bleeding disorders are important differentials to consider […] Hormonal therapy aims to stabilise the endometrium […] Excessive menstrual flow is defined as any of the following: 7 days duration or 80 mL, necessitating changing a super pad/tampon more than every 2 hours, causing symptomatic anaemia, causing lifestyle disturbance […] Anovulatory uterine bleeding is excessive noncyclic uterine bleeding related to immaturity of the hypothalamic-pituitary-ovarian axis (in the absence of structural uterine lesions or systemic disease) […] If a bleeding disorder is suspected, consider Platelet function assay (PFA) 100 and von Willebrand screen. These tests should not be done during acute bleeding or with recent NSAID use […] Treatment is targeted to the underlying cause; for anovulatory bleeding, the objective is to stabilise the endometrium (oestrogen for initial haemostasis and progestins for extended endometrial stability) […] All patients may benefit from iron supplements.

• #1 Heavy menstrual bleeding: work-up and management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6142441/

  HMB manifest by flooding and/or prolonged menses, or HMB accompanied by a personal or family history of bleeding is very suggestive of a bleeding disorder and should prompt a referral to a hematologist. […] The patients evaluation will include a review of the history (menstrual, medical, bleeding, and medications), a review of the gynecologic evaluation, and a laboratory assessment for an underlying bleeding disorder. A previously undiagnosed underlying bleeding disorder accompanies 5% to 24% of women with HMB and an even higher proportion of adolescents with HMB. […] The goal of treatment is to reduce HMB. Not only will the treatment strategy depend on whether there is ovulatory dysfunction, uterine pathology, or an abnormality of coagulation, the treatment strategy will also depend on the age of the patient and her desire for immediate or long-term fertility.

• #1 Heavy Menstrual Bleeding (Menorrhagia) | Children’s Hospital of Philadelphia

  https://www.chop.edu/conditions-diseases/heavy-menstrual-bleeding-menorrhagia

  Heavy menstrual bleeding, also known as menorrhagia, is a menstrual condition characterized by heavy or prolonged menstrual periods. […] If your teen has abnormally heavy periods that are causing pain or substantially affecting daily activities, your teen should be examined by a specialist in adolescent medicine or gynecology. […] The diagnosis of heavy menstrual bleeding begins with a series of questions about the patients overall medical history, medications, menstruation cycle, sexual activity and any pregnancies. […] A physical examination will follow the interview, along with a pelvic examination if appropriate. Additional tests may be performed to rule out other potential causes for the teens heavy menstruation. […] At Childrens Hospital of Philadelphia, adolescent medicine specialists are able to manage the majority of cases of heavy menstrual bleeding. However, if necessary, a coordinated approach may be used with specialists from gynecology, hematology, radiology and endocrinology and others to accurately diagnose and treat patients with heavy menstrual bleeding.

• #1 Heavy menstrual bleeding: work-up and management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6142441/

  The goal of treatment is to reduce HMB. Not only will the treatment strategy depend on whether there is ovulatory dysfunction, uterine pathology, or an abnormality of coagulation, the treatment strategy will also depend on the age of the patient and her desire for immediate or long-term fertility. […] HMB can result from an abnormality of the uterus (polyps, adenomyosis, leiomyoma, malignancy, or hyperplasia), an abnormality of the endometrium, a disorder of ovulation, an iatrogenic cause, an abnormality of coagulation, or some cause not yet recognized. […] A woman with HMB usually seeks care from a gynecologist or other womens health care provider, and it is usually that provider who initiates the work-up. The goal of the work-up is to determine whether there is a uterine/endometrial abnormality, a disorder of ovulation, or a disorder of coagulation.

• #1 Heavy menstrual bleeding – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/menorrhagia/symptoms-causes/syc-20352829

  Seek medical help before your next scheduled exam if you have: Vaginal bleeding so heavy it soaks at least one pad or tampon an hour for more than two hours in a row. Bleeding between periods or unusual vaginal bleeding. Vaginal bleeding after menopause. […] In some cases, the reason for heavy menstrual bleeding is unknown. But a number of conditions may cause heavy menstrual bleeding. They include: Hormones being out of balance. In a typical menstrual cycle, there’s a balance between the hormones estrogen and progesterone. This controls the buildup of the lining of the uterus. The lining of the uterus also is known as the endometrium. This lining is shed during a menstrual period. When hormones are out of balance, the lining becomes too thick and sheds by way of heavy menstrual bleeding or unexpected bleeding between periods.

• #1 Heavy Menstrual Bleeding: The Rough Road from Diagnosis to Treatment – Uterine Fibroids: Contemporary Approaches

  https://www.medpagetoday.com/resource-centers/uterine-fibroids-contemporary-approaches/heavy-menstrual-bleeding-rough-road-diagnosis-treatment/3370

  Researchers identified “a strong unmet need for information about heavy periods.” […] The lack of patient understanding was not the only barrier identified. A significant finding was the proportion of women who did not receive a diagnosis after being told by their doctors that their heavy periods were normal. […] This indicates that many physicians may not be aware of how to identify HMB, and indeed there are few resources available to HCPs that provide credible, up-to-date information to facilitate effective identification, counselling, and treatment of HMB. […] Identification of HMB based on impact on quality of life should be prioritized over identification based on quantification of menstrual blood loss because the latter is hard for patients to relate to and may result in many women who would benefit from treatment remaining undiagnosed.

• #1 Evaluation and Management of Abnormal Uterine Bleeding in Premenopausal Women | AAFP

  https://www.aafp.org/pubs/afp/issues/2012/0101/p35.html

  Women at low risk of endometrial cancer and women with benign endometrial histology who have continued irregular or excessive uterine bleeding despite treatment should undergo imaging to rule out concomitant structural changes. […] Hysterectomy is the definitive treatment for excessive uterine bleeding in women who no longer wish to conceive.

• #1

  https://bpac.org.nz/2019/bleeding.aspx

  A variety of hormonal and non-hormonal pharmacological treatment options are available to manage heavy menstrual bleeding. Treatment selection will be influenced by the cause of bleeding, the need for contraception, any contraindications to oestrogen or progestogen use, and patient preference. […] Laboratory and imaging tests that may be indicated when investigating heavy menstrual bleeding include: Complete blood count – recommended for all patients with heavy menstrual bleeding. Guidelines recommend against routinely including ferritin; in practice, however, it may often be appropriate to add this test, e.g. if bleeding has been ongoing or there are other factors contributing to iron deficiency such as diet. […] Key messages for heavy menstrual bleeding: Structural causes of heavy menstrual bleeding become more common with increasing age; fibroids, polyps, adenomyosis and malignancy are rare causes of heavy menstrual bleeding in those aged 40 years although there are some parts of the country where there is a high incidence of malignancy in younger women. Ultrasound investigation, pipelle biopsy or hysteroscopy are necessary to diagnose structural abnormalities or malignancy.

• #1 Heavy menstrual bleeding diagnosis and medical management | Contraception and Reproductive Medicine | Full Text

  https://contraceptionmedicine.biomedcentral.com/articles/10.1186/s40834-017-0047-4

  However, other structural causes such as polyps (AUB-P), adenomyosis (AUB-A) and leiomyoma (AUB-L), as well as non-structural causes of coagulopathy (AUB-C) are also commonly related to HMB. […] The coagulopathy (AUB-C) cause of HMB includes systemic disorders of hemostasis or coagulopathies. […] Von Willebrand disease is reported to be most common cause in this group that related to HMB with the prevalence of 13%. […] Approximately 90% of AUB-C could be identified as a coagulopathy with use of the structured history screening criteria. […] No single pathway explains the cause of HMB. This has resulted in several therapeutic interventions specifically altering different pathways resulting in reduced blood loss with menstruation. […] The American College of Obstetricians and Gynecologists proposed that medical treatment is the first line therapy for acute AUB women without systemic hematologic disorders, while surgical treatment would be considered based on stability of the patient, severity of bleeding, underlying disease, contraindications to medical treatment as well as lack of response to medical treatment.

• #1 Heavy menstrual bleeding diagnosis and medical management | Contraception and Reproductive Medicine | Full Text

  https://contraceptionmedicine.biomedcentral.com/articles/10.1186/s40834-017-0047-4

  The treatment goal is to control the current episode of heavy bleeding and to reduce menstrual blood loss in subsequent cycles. […] The American College of Obstetricians and Gynecologists suggested that the selection of treatment for each woman depends on clinical stability, overall acuity, suspected etiology of bleeding, desired for future fertility and underlying medical problems. […] The component of PALM group includes structural causes; Polyp, Adenomyosis, Leiomyoma, Malignancy and COEIN group includes nonstructural causes: Coagulopathy, Ovulatory Disorders, Endometrial Disorders, Iatrogenic Causes, and Not Classified. […] HMB is a specific term, which is an abnormal volume of menstrual effluent and/or affecting the womans quality of life. […] Women with HMB would be defined as having AUB due to endometrial dysfunction (AUB-E) as many of them do not have identifiable structural or histological abnormality.

• #1 Heavy menstrual bleeding – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/menorrhagia/diagnosis-treatment/drc-20352834

  Your doctor can make a diagnosis of heavy menstrual bleeding or abnormal uterine bleeding only after it’s known that something else isn’t causing your condition. These causes may include menstrual disorders, medical conditions or medicines. […] Results of these initial tests may lead to more testing, including: […] If you have heavy menstrual bleeding from taking hormone medicine, you may need to stop or change your medicine. […] If you have anemia due to heavy menstrual bleeding, you may need to take iron supplements. If your iron levels are low but you’re not yet anemic, you may be started on iron supplements instead of waiting until you become anemic. […] Sometimes heavy menstrual bleeding is a sign of another condition, such as thyroid disease. In those cases, treating the condition usually results in lighter periods.

• #1 Heavy Menstrual Bleeding | ACOG

  https://www.acog.org/womens-health/faqs/heavy-menstrual-bleeding

  If medication does not reduce your bleeding, a surgical procedure may be recommended: Endometrial ablation destroys the lining of the uterus. It stops or reduces menstrual bleeding. […] Hysterectomy is surgical removal of the uterus. Hysterectomy is used to treat fibroids and adenomyosis when other types of treatment have failed or are not an option. It also is used to treat endometrial cancer. After the uterus is removed, a woman will no longer have periods and can no longer get pregnant.

• #1 Heavy menstrual bleeding diagnosis and medical management | Contraception and Reproductive Medicine | Full Text

  https://contraceptionmedicine.biomedcentral.com/articles/10.1186/s40834-017-0047-4

  The medical treatments include hormonal and non-hormonal options and the most effective in term of bleeding reduction are LNG-IUS, CHCs, tranexamic acid and long courses of oral progesterone. […] Although heavy menstrual bleeding is a common gynecological problem, there is a challenge in diagnosis and treatment as the condition cannot not be explained by a single hemostatic pathway.

• #1 Heavy periods? You might have an undiagnosed bleeding disorder

  https://theconversation.com/heavy-periods-you-might-have-an-undiagnosed-bleeding-disorder-114410

  About 30 per cent of all women report heavy menstrual periods at some point during their reproductive years. Up to 15 per cent of these have an underlying bleeding disorder and yet most have never been diagnosed, leaving thousands of women to suffer from a treatable problem. […] As a hematologist and clinician scientist at Queens University who cares for patients with inherited bleeding disorders, it is a major source of frustration for me that women with bleeding disorders can wait up to 15 years to get appropriate testing and treatment. […] I worry even more about what happens to those who never get diagnosed. These women are at risk of acute hemorrhages leading to blood transfusions and the need for hysterectomy. […] Key features of heavy and abnormal periods include having to change pads or tampons more than every hour, having iron deficiency anemia, frequently soaking through your sheets at night and bleeding that lasts longer than seven days.

• #2 Menorrhagia (Heavy Menstrual Bleeding): Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/17734-menorrhagia-heavy-menstrual-bleeding

  Menorrhagia or heavy menstrual bleeding is a common disorder among people who menstruate. It refers to bleeding lasting longer than seven days and involves bleeding more than is typical during menstruation. […] Contact a healthcare provider if any of these scenarios apply to you. They can evaluate your symptoms and figure out whats causing you to have heavy periods. Then, they can recommend treatment options to manage heavy blood flow during your period. […] Heavy menstrual bleeding is common, affecting anywhere from 27% to 54% of people who menstruate. […] Heavy menstrual bleeding interferes with your quality of life. Many people with heavy periods assume that periods are supposed to be inconvenient and uncomfortable. […] Menorrhagia can have many causes, ranging from hormone-related issues to medical conditions or medications.

• #2 About Heavy Menstrual Bleeding | Bleeding Disorders in Women | CDC

  https://www.cdc.gov/female-blood-disorders/about/heavy-menstrual-bleeding.html

  Periods that last for more than 7 days are considered heavy. […] Periods that require a new tampon or pad after less than 2 hours or involve passing large clots are considered heavy. […] Your healthcare provider can determine if you might need testing for a possible bleeding disorder. […] Finding out if a woman has heavy menstrual bleeding often is not easy, because each person might think of „heavy bleeding” in a different way. […] If you have bleeding that lasts longer than 7 days per period or is so heavy that you have to change your pad or tampon nearly every hour, you need to talk with your healthcare provider. […] To find out if you have heavy menstrual bleeding, your healthcare provider will ask you about your medical history and menstrual cycles. […] Your healthcare provider may also ask if any of your family members have had heavy menstrual bleeding.

• #2 Heavy Menstrual Bleeding | ACOG

  https://www.acog.org/womens-health/faqs/heavy-menstrual-bleeding

  Heavy menstrual bleeding is very common. About one third of women seek treatment for it. Heavy menstrual bleeding is not normal. It can disrupt your life and may be a sign of a more serious health problem. If you are worried that your menstrual bleeding is too heavy, tell your obstetrician-gynecologist (ob-gyn). […] Any of the following can be a sign of heavy menstrual bleeding: Bleeding that lasts more than 7 days. Bleeding that soaks through one or more tampons or pads every hour for several hours in a row. Needing to wear more than one pad at a time to control menstrual flow. Needing to change pads or tampons during the night. Menstrual flow with blood clots that are as big as a quarter or larger. […] Heavy menstrual bleeding may be a sign of an underlying health problem that needs treatment. Blood loss from heavy periods also can lead to a condition called iron-deficiency anemia. Severe anemia can cause shortness of breath and increase the risk of heart problems.

• #2 Heavy menstrual bleeding – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/menorrhagia/symptoms-causes/syc-20352829

  Some women have menstrual bleeding that is heavy or lasts for more than a few days. This condition used to be called menorrhagia. Heavy menstrual bleeding is a common concern. But most women don’t have enough blood loss for it to be called heavy menstrual bleeding. […] With heavy menstrual bleeding, blood flow and cramping make it harder to do your usual activities. If you dread your period because you have heavy menstrual bleeding, talk with your doctor. There are many treatments that can help. […] Symptoms of heavy menstrual bleeding may include: Soaking through one or more sanitary pads or tampons every hour for several hours in a row. Needing double sanitary protection to control your menstrual flow. Getting up at night to change sanitary pads or tampons. Bleeding for more than a week. Passing blood clots larger than a quarter. Limiting daily activities due to heavy menstrual flow. Feeling tired, fatigued or short of breath as the result of blood loss.

• #2 Heavy Menstrual Bleeding (Menorrhagia) | Texas Children’s

  https://www.texaschildrens.org/content/conditions/heavy-menstrual-bleeding-menorrhagia

  Menorrhagia is a medical term for heavy or prolonged menstrual bleeding, or the excessive loss of blood during your period. […] Patients can be seen by Texas Children’s experts in Adolescent Medicine and Pediatric and Adolescent Gynecology. […] Diagnosis starts with a thorough medical history and physical exam, including a pelvic exam. […] Your doctor may ask you to keep a record of your period, including when you started and stopped bleeding each month, how heavy the flow was, the number of pads and tampons used, and if they are soaked. […] Additional testing may include: Blood tests – to check for anemia and other abnormalities, Urinalysis, Pap test – to check for infection, inflammation or precancerous changes, Biopsy – a tiny tissue sample taken from the lining of your uterus is examined under a microscope, Imaging tests – including an ultrasound or sonohysterogram to create images of your internal organs and look for abnormalities, Hysteroscopy – a small, lighted telescope (hysteroscope) is inserted through your vagina and cervix to examine inside the uterus, Dilation and curettage (D&C) – a surgical procedure in which a tissue sample is collected from the lining of your uterus and examined in the laboratory.

• #2 Heavy menstrual bleeding: diagnosis and management options – The Pharmaceutical Journal

  https://pharmaceutical-journal.com/article/ld/heavy-menstrual-bleeding-diagnosis-and-management-options

  Heavy menstrual bleeding has a major impact on a woman’s quality of life. This article covers the most recent guidance and treatment options available. Menorrhagia, also known as heavy menstrual bleeding (HMB), is widely accepted as the loss of menstrual blood of ≥60–80ml per cycle, compared with 30–40ml for the average woman with ‘normal’ periods. Women with HMB may describe having to use both tampons and sanitary towels, having to frequently change sanitary towels, and/or the presence of large menstrual clots. The National Institute for Health and Care Excellence (NICE) defines HMB more holistically as “excessive blood loss that interferes with the woman’s physical, emotional, social and material quality of life.” […] Obtaining a detailed history from the patient is the best way to diagnose HMB, with physical examinations and tests performed to exclude more serious conditions. History-taking should include questions on the nature of the bleeding, the patient’s perspective on whether this variation falls within normal fluctuations in their cycle and blood loss, and how it is affecting their quality of life, as well as questions on their medical history. Women aged 55 years and over who have post-menopausal bleeding should be referred using a suspected cancer pathway referral for an appointment within two weeks as per NICE guidelines.

• #2 Heavy menstrual bleeding: work-up and management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6142441/

  HMB manifest by flooding and/or prolonged menses, or HMB accompanied by a personal or family history of bleeding is very suggestive of a bleeding disorder and should prompt a referral to a hematologist. […] The patients evaluation will include a review of the history (menstrual, medical, bleeding, and medications), a review of the gynecologic evaluation, and a laboratory assessment for an underlying bleeding disorder. A previously undiagnosed underlying bleeding disorder accompanies 5% to 24% of women with HMB and an even higher proportion of adolescents with HMB. […] The goal of treatment is to reduce HMB. Not only will the treatment strategy depend on whether there is ovulatory dysfunction, uterine pathology, or an abnormality of coagulation, the treatment strategy will also depend on the age of the patient and her desire for immediate or long-term fertility.

• #2 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Diagnosis-of-Menorrhagia.aspx

  Menorrhagia is a symptom of an underlying pathology in many women. It is defined as excessive bleeding (over 80 ml of blood per period), for over 7 days and at regular intervals. […] Diagnosis of the underlying condition is based on these causes. […] Examination begins with a detailed history of the condition. […] Patient is asked to maintain a menstrual diary to record the time and duration of her periods. […] History of similar episodes in the family, use of certain drugs like Warfarin, age, use of intrauterine contraceptive devices is also important to pin point the cause of heavy bleeding. […] After history a complete physical examination is undertaken. […] Medical disorders, liver, kidney disease, thyroid problems, bleeding disorders may be detected by clinical examination.

• #2 Diagnosis of Heavy Menstrual Bleeding

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5779565/

  In conclusion, the PBAC is a useful measure for accurately diagnosing HMB. […] The first step in imaging tests is the transvaginal ultrasound. If this is inconclusive or if intracavitary abnormalities are suspected then the physician can perform an saline infusion sonography. […] Saline infusion sonography/gel infusion sonography are reliable diagnostic procedures for excluding intracavitary abnormalities in women with HMB.

• #2 Heavy Menstrual Bleeding: The Rough Road from Diagnosis to Treatment – Uterine Fibroids: Contemporary Approaches

  https://www.medpagetoday.com/resource-centers/uterine-fibroids-contemporary-approaches/heavy-menstrual-bleeding-rough-road-diagnosis-treatment/3370

  Researchers identified “a strong unmet need for information about heavy periods.” […] The lack of patient understanding was not the only barrier identified. A significant finding was the proportion of women who did not receive a diagnosis after being told by their doctors that their heavy periods were normal. […] This indicates that many physicians may not be aware of how to identify HMB, and indeed there are few resources available to HCPs that provide credible, up-to-date information to facilitate effective identification, counselling, and treatment of HMB. […] Identification of HMB based on impact on quality of life should be prioritized over identification based on quantification of menstrual blood loss because the latter is hard for patients to relate to and may result in many women who would benefit from treatment remaining undiagnosed.

• #2 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Diagnosis-of-Menorrhagia.aspx

  Other diagnosis should be considered. […] The work up for Menorrhagia includes complete and routine blood tests. […] A low haemoglobin signifies anemia due to excessive blood loss. […] Iron assessments in blood may also help detect anemia. […] Increased White Blood Cell count may signify pelvic inflammations. […] Platelet count and assessment of coagulation of blood may help detect bleeding disorders. […] Thyroid function tests and prolactin level helps detect problems of the thyroid gland and pituitary gland that may be causing menstrual abnormalities. […] Liver function and kidney function tests are used to detect underlying liver or kidney disorders. […] Pregnancy should be excluded by routine pregnancy tests. […] Hormone assays like assessment of LH (luteinizing hormone), FSH (follicle stimulating hormone), estrogen and progestrones are done to exclude hormonal disorders.

• #2 Abnormal Uterine Bleeding – Gynecology and Obstetrics – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/gynecology-and-obstetrics/menstrual-abnormalities/abnormal-uterine-bleeding

  CBC is routinely done. Anemia may be severe in women who regularly have heavy periods. […] If iron deficiency anemia is suspected in women who have chronic, heavy bleeding, the serum ferritin level, which reflects body iron stores, is measured. […] All women of reproductive age with AUB should have a pregnancy test. […] Patients with AUB-O (ovulatory dysfunction) have uterine bleeding that occurs at unpredictable times, may vary widely in volume, and is not accompanied cyclic changes in basal body temperature. […] Control of bleeding, usually with a nonsteroidal anti-inflammatory drug (NSAID), tranexamic acid, or hormone therapy. […] If medications are needed to control bleeding, treat with NSAIDs, tranexamic acid, estrogen/progestin OCs, levonorgestrel-releasing IUDs, gonadotrophin agonists or antagonists, or other hormones. […] Treat structural lesions or bleeding that does not respond to medications with a procedure (eg, hysteroscopy, endometrial ablation, hysterectomy).

• #2 Menorrhagia: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/255540-overview

  Laboratory studies that may be useful include the following: Complete blood cell count, Iron studies (eg, total iron-binding capacity [TIBC] and total iron), Thyroid function tests and prolactin level, Liver function tests (LFTs) and renal function tests (eg, blood urea nitrogen [BUN] and creatinine), Hormone assays (eg, luteinizing hormone [LH], follicle-stimulating hormone [FSH], and androgen) for suspected polycystic ovary syndrome (PCOS); adrenal function tests for suspected adrenal tumors, Coagulation factor studies (expensive and to be used sparingly). […] Imaging studies and other diagnostic measures that may be helpful include the following: Pelvic ultrasonography, Sonohysterography (saline-infusion sonography), Cervical specimens (eg, Pap smear, sexually transmitted infection [STI] testing), Endometrial biopsy (EMB), Hysteroscopy.

• #2 Screening and Management of Bleeding Disorders in Adolescents With Heavy Menstrual Bleeding | ACOG

  https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2019/09/screening-and-management-of-bleeding-disorders-in-adolescents-with-heavy-menstrual-bleeding

  Heavy menstrual bleeding is defined as excessive menstrual blood loss that interferes with a woman’s physical, social, emotional, or material quality of life. […] Evaluation of adolescent girls who present with heavy menstrual bleeding should include assessment for anemia from blood loss, including serum ferritin, the presence of an endocrine disorder leading to anovulation, and evaluation for the presence of a bleeding disorder. […] The first-line approach to acute bleeding in the adolescent is medical management; surgery should be reserved for those who do not respond to medical therapy. […] Heavy menstrual bleeding at menarche and in adolescence may be an important sentinel for an underlying bleeding disorder. […] If obstetriciangynecologists suspect that a patient has a bleeding disorder, they should work in coordination with a hematologist for laboratory evaluation and medical management.

• #2 Heavy Menstrual Bleeding Diagnosis and Treatment Options – Prof. Dr. Basak Baksu

  https://basakbaksu.com.tr/en/yogun-adet-kanamasi-tanisi/

  The doctor then performs a physical examination. A manual examination of the lower abdomen reveals conditions such as uterine size or tenderness. The structure of the uterus and ovaries is evaluated during the pelvic examination. If there is a visible abnormality, imaging methods are used. These findings determine the direction of the tests to be performed in the following stages. […] One of the most commonly used methods in the diagnosis process is ultrasonography. Gynecological ultrasound shows the inner layer of the uterus and muscle tissue in detail. Myoma, polyp or thickened endometrium are easily detected with this method. Ultrasound performed vaginally increases image quality and provides clearer results. […] Blood tests are important in the diagnosis of menorrhagia. A blood count, especially for anemia, reveals the degree of blood loss. If hemoglobin levels are low, this may indicate severe iron deficiency. In addition, hormonal and systemic causes should be investigated.

• #2 Heavy Menstrual Bleeding: Symptoms and Treatment | MedPark Hospital

  https://www.medparkhospital.com/en-US/disease-and-treatment/heavy-menstrual-bleeding

  A transvaginal ultrasound to evaluate organs and tissues in your pelvic region. […] A sonohysterogram or saline-infusion sonography can assess the lining of the uterus by filling it with saline. This method can detect any intrauterine lesions more accurately than a regular ultrasound. […] An endometrial biopsy can identify cancer or abnormalities of the endometrium. […] Magnetic resonance imaging (MRI) can display abnormal structures inside the uterus. […] A hysteroscopy can inspect the vagina, cervix, and uterus for polyps, fibroids, or other abnormalities which are removable in the same sitting. […] A cervical culture can identify an infection in the uterus. […] If you experience symptoms, it is advisable to seek guidance from your gynecologist for an accurate diagnosis and effective treatment to address your condition.

• #2 Exams and Tests Used to Investigate Menstrual Disorders – Your Period

  https://www.yourperiod.ca/abnormal-pain-and-menstrual-bleeding/exams-and-tests-used-to-investigate-menstrual-disorders/

  If you have abnormal menstrual bleeding, you may require testing in order to determine the underlying problem. […] If you are experiencing abnormal menstrual bleeding, your doctor will likely recommend that you undergo some testing. […] This list of tests does not include blood tests that you might take, and is specifically referring to physical exam, imaging, radiology, and biopsies. […] MRI can be used to help diagnose many of the structural causes of heavy menstrual bleeding, such as fibroids, polyps, endometriosis, and adenomyosis. […] This procedure involves the removal of tissue from the inside of the uterus. It can be used to diagnose or treat some causes of heavy menstrual bleeding, such as fibroids, polyps, or uterine cancer.

• #2 Menorrhagia Workup: Laboratory Studies, Imaging Studies, Procedures

  https://emedicine.medscape.com/article/255540-workup

  EMB findings are used to assess the stage and proliferation of the endometrial stroma and glands. Many studies have been done to compare the results of EMB and dilation and curettage (DC). Both tests are accepted as equal in value and are approximately 98% accurate. […] Understanding EMB results is essential for any physician treating menorrhagia. If no tissue is returned after an EMB is performed, particularly in postmenopausal patients, most likely the endometrium is atrophic and requires estrogen. Simple proliferative endometrium is normal and does not require treatment. If sampling is insufficient or an EMB cannot be performed, a diagnostic hysteroscopy with DC can be performed. No further sampling is needed for premenopausal women if biopsy results are normal, but further evaluation should be pursued if symptoms persist or the patient is postmenopausal. […] Any biopsy that reveals endometrial hyperplasia with atypia or carcinoma should prompt immediate referral to a gynecologic oncologist for treatment outlined by current oncology protocols associated with the grade and stage of the cancer.

• #2 Menorrhagia –Diagnosis and Treatment : Emergency Care BC

  https://emergencycarebc.ca/clinical_resource/clinical-summary/menorrhagia-diagnosis-and-treatment/

  Menorrhagia, or prolonged or excessive uterine bleeding, can have a significant impact on quality of life. […] ~1 in 20 women between 30-49 years of age will present with heavy menstruation each year. […] Heavy bleeding (>80cc of blood loss/cycle – hard to quantify clinically). […] Some patients may have anemia, fatigue, and weakness. […] Anovulatory cycles are a common cause of menorrhagia: More common at menarche and menopause and with PCOS and obesity. […] Symptoms classically include: hx of irregular periods, late period, and/or mid-cycle spotting. […] Heavy bleeding from menarche / family history of bleeding disorders: INR, PTT, Fibrinogen, von Willebrand factor antigen, Factor VIII. […] Endometrial Biopsy Indications: >40 yrs of age. […] Failure of medical treatment. […] Woman of any age with past anovulatory cycles—patient describes irregular or infrequent periods on hx. […] Menorrhagia may present with significant anemia and require emergent care. […] Progestin (medroxyprogesterone) is the most frequently prescribed medicine for menorrhagia (especially anovulatory). […] Hysterectomy = definitive treatment for abnormal uterine bleeding.

• #2 Heavy Menstrual Bleeding: Symptoms and Treatment | MedPark Hospital

  https://www.medparkhospital.com/en-US/disease-and-treatment/heavy-menstrual-bleeding

  Heavy menstrual bleeding occurs when your menstrual blood loss is more than 80 milliliters in a cycle or your period lasts longer than seven days. […] Heavy menstrual bleeding can lead to anemia, weakness, and fatigue. […] If you have heavy bleeding that you need to change your tampon or pad every hour, experience vaginal bleeding between periods or unusual vaginal bleeding, or have bleeding after menopause, consult with a gynecologist for proper diagnosis and treatment. […] How is heavy menstrual bleeding diagnosed? […] Your doctor will inquire about your symptoms and conduct a physical and pelvic exam. […] Blood tests to check your iron levels and determine if you have anemia, thyroid disease, or a bleeding disorder. […] A Pap test can diagnose if you have an infection, inflammation, or indication of cancer.

• #2 Patient education: Heavy periods (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/heavy-periods-beyond-the-basics

  A biopsy of the tissue inside of the uterus – This is called an endometrial biopsy. It is usually done in a doctor’s office. […] A hysteroscopy – This test uses a small scope to look inside the uterus. This may be performed in a doctor’s office or in an operating room as day surgery. […] If you have heavy menstrual bleeding, the best treatment for you will depend on: The cause of your bleeding, Your preferences, Whether you want to prevent pregnancy, Whether you might want to be able to get pregnant in the future. […] Your health care provider will probably recommend treatment with one or more medicines first. If these treatments do not reduce bleeding enough, surgical treatment might be an option. […] If you have growths in your uterus, such as polyps or fibroids, getting treatment to remove them can reduce or eliminate heavy bleeding.

• #2 Heavy Periods – Menorrhagia | Dr. Sarah Choi – Gynaecologist and Advanced Laparoscopic Surgeon in Sydney

  http://www.drsarahchoi.com.au/menorrhagia.html

  This treatment package will help you to: rule out the rare possibility of cancer on the lining of the uterus; confirm the presence/absence of polyp or fibroid inside the uterus; remove any abnormal growth inside the uterus; AND have treatment of menorrhagia at the same time. […] Part 1- Diagnosis First of all, the gynaecological surgeon performs a hysteroscopy to carefully look inside of the uterus. […] The surgeon will then obtain a biopsy at the lining of the uterus (endometrial biopsy), usually by a minor procedure called D&C. This is an important step to rule out cancer inside the uterus. […] Fibroids are one of the most common causes of heavy menstrual bleeding. […] Hysterectomy is surgical removal of uterus. It is the definitive cure of menstrual problems for women who have no desire for pregnancies in the future. […] Every women is individual and her situation requires an individual plan of management. If you think these issues relate to you, arrange a personal consultation with us to discuss your menstrual issues and know more about our treatment programmes.

• #2 Heavy periods aren’t normal in teens – and might indicate a serious concern | Pediatrics | Prevention | Women’s Health | UT Southwestern Medical Center

  https://utswmed.org/medblog/heavy-periods-young-women/

  To effectively treat heavy periods, young women must first receive an accurate diagnosis. […] However, the most pressing concern is that when young women seek medical help for heavy periods, too many doctors brush the symptoms aside as normal during adolescence (its not normal) or misdiagnose it as a hormonal imbalance (too much estrogen or not enough progesterone). […] Teen girls with these symptoms need additional screening for serious bleeding disorders: […] We founded the Young Womens Blood Disorders (YWBD) Program to properly diagnose and treat young women with heavy periods and related symptoms. […] To properly identify the cause of heavy bleeding, we have in-depth conversations with patients about family history, because many of the bleeding disorders have a genetic component to them. […] Many young women suffer through heavy periods not realizing they could be a sign of something more serious. Our goal is to help these patients optimize their health and regain a higher quality of life by getting the appropriate diagnosis and treatment from experts who know the symptoms to look for.

• #2 Heavy menstrual bleeding diagnosis and medical management | Contraception and Reproductive Medicine | Full Text

  https://contraceptionmedicine.biomedcentral.com/articles/10.1186/s40834-017-0047-4

  However, other structural causes such as polyps (AUB-P), adenomyosis (AUB-A) and leiomyoma (AUB-L), as well as non-structural causes of coagulopathy (AUB-C) are also commonly related to HMB. […] The coagulopathy (AUB-C) cause of HMB includes systemic disorders of hemostasis or coagulopathies. […] Von Willebrand disease is reported to be most common cause in this group that related to HMB with the prevalence of 13%. […] Approximately 90% of AUB-C could be identified as a coagulopathy with use of the structured history screening criteria. […] No single pathway explains the cause of HMB. This has resulted in several therapeutic interventions specifically altering different pathways resulting in reduced blood loss with menstruation. […] The American College of Obstetricians and Gynecologists proposed that medical treatment is the first line therapy for acute AUB women without systemic hematologic disorders, while surgical treatment would be considered based on stability of the patient, severity of bleeding, underlying disease, contraindications to medical treatment as well as lack of response to medical treatment.

• #2 Heavy Periods (Menorrhagia): Causes and Treatment

  https://patient.info/womens-health/periods-and-period-problems/heavy-periods-menorrhagia

  Having surgery is not a first-line treatment but it can be an option if the above treatments do not help or are unsuitable. […] Some women have very heavy bleeding during a period. This can cause a lot of blood loss, and distress. One option as an emergency treatment is to take a course of norethisterone or medroxyprogesterone tablets.

• #2 Heavy Menstrual Bleeding | ACOG

  https://www.acog.org/womens-health/faqs/heavy-menstrual-bleeding

  Many things can cause heavy menstrual bleeding. Some of the causes include the following: Fibroids and polyps, Adenomyosis, Irregular ovulation, Bleeding disorders, Medications, Cancer, Other causes. […] When you see your ob-gyn about heavy menstrual bleeding, you may be asked about past and present illnesses and surgical procedures, pregnancy history, medications, including those you buy over the counter, your birth control method, your menstrual cycle. […] You may have a physical exam, including a pelvic exam. Several lab tests may be done. You may have a pregnancy test and tests for some sexually transmitted infections (STIs). […] Medications often are tried first to treat heavy menstrual bleeding: Heavy bleeding caused by problems with ovulation, endometriosis, PCOS, and fibroids often can be managed with certain hormonal birth control methods.

• #2 Screening and Management of Bleeding Disorders in Adolescents With Heavy Menstrual Bleeding | ACOG

  https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2019/09/screening-and-management-of-bleeding-disorders-in-adolescents-with-heavy-menstrual-bleeding

  Evaluation of adolescent girls who present with heavy menstrual bleeding should include assessment for anemia from blood loss, including serum ferritin, the presence of an endocrine disorder leading to anovulation, and evaluation for the presence of a bleeding disorder. […] Adolescents who are hemodynamically unstable or actively bleeding heavily should be hospitalized for management. […] Use of antifibrinolytics such as tranexamic acid or aminocaproic acid in oral and intravenous form may be used to stop bleeding. […] After correction of acute heavy menstrual bleeding, maintenance hormonal therapy can include combined hormonal contraceptives, oral and injectable progestins, and levonorgestrel-releasing intrauterine devices. […] Nonmedical procedures should be considered when there is a lack of response to medical therapy, if the patient is clinically unstable despite initial measures, or when severe heavy bleeding warrants further investigation, such as an examination under anesthesia.

• #2 Heavy menstrual bleeding: work-up and management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6142441/

  The goal of treatment is to reduce HMB. Not only will the treatment strategy depend on whether there is ovulatory dysfunction, uterine pathology, or an abnormality of coagulation, the treatment strategy will also depend on the age of the patient and her desire for immediate or long-term fertility. […] HMB can result from an abnormality of the uterus (polyps, adenomyosis, leiomyoma, malignancy, or hyperplasia), an abnormality of the endometrium, a disorder of ovulation, an iatrogenic cause, an abnormality of coagulation, or some cause not yet recognized. […] A woman with HMB usually seeks care from a gynecologist or other womens health care provider, and it is usually that provider who initiates the work-up. The goal of the work-up is to determine whether there is a uterine/endometrial abnormality, a disorder of ovulation, or a disorder of coagulation.

• #2 Management of Heavy Menstrual Bleeding: Causes, Treatment, and Solutions | Nurture Gynaecology

  https://nurturegynaecology.com.au/management-of-heavy-menstrual-bleeding-causes-treatment-and-solutions/

  Endometrial ablation is a surgical procedure that involves the removal of the endometrium, or the lining of the uterus, to help reduce excessive menstrual bleeding. […] Uterine fibroid removal, or myomectomy, is a surgical procedure to remove uterine fibroids, also known as leiomyomas. […] Another surgical treatment option for heavy menstrual bleeding is the surgical removal of the uterus, a hysterectomy. […] If heavy menstrual bleeding is affecting your quality of life, it is crucial to seek professional help from a healthcare professional. […] Consulting a doctor is essential in ensuring an accurate diagnosis and obtaining the appropriate treatment tailored to your particular needs and circumstances. […] Heavy menstrual bleeding can have a significant impact on your day to day quality of life, but it doesnt have to be an inevitable part of being a woman. […] By understanding the causes, symptoms, and various treatment options, as well as implementing coping strategies and lifestyle changes, you can effectively manage heavy menstrual bleeding and find much needed comfort and relief.

• #3 Heavy menstrual bleeding: work-up and management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6142441/

  Heavy menstrual bleeding (HMB), which is the preferred term for menorrhagia, affects 90% of women with an underlying bleeding disorder and 70% of women on anticoagulation. HMB can be predicted on the basis of clots of 1 inch diameter, low ferritin, and flooding (a change of pad or tampon more frequently than hourly). The goal of the work-up is to determine whether there is a uterine/endometrial cause, a disorder of ovulation, or a disorder of coagulation. […] HMB manifest by flooding and/or prolonged menses, or HMB accompanied by a personal or family history of bleeding is very suggestive of a bleeding disorder and should prompt a referral to a hematologist. The evaluation will include the patients history, pelvic examination, and/or pelvic imaging, and a laboratory assessment for anemia, ovulatory dysfunction, underlying bleeding disorder, and in the case of the patient on anticoagulation, assessment for over anticoagulation.

• #3 Heavy menstrual bleeding – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/menorrhagia/symptoms-causes/syc-20352829

  Some women have menstrual bleeding that is heavy or lasts for more than a few days. This condition used to be called menorrhagia. Heavy menstrual bleeding is a common concern. But most women don’t have enough blood loss for it to be called heavy menstrual bleeding. […] With heavy menstrual bleeding, blood flow and cramping make it harder to do your usual activities. If you dread your period because you have heavy menstrual bleeding, talk with your doctor. There are many treatments that can help. […] Symptoms of heavy menstrual bleeding may include: Soaking through one or more sanitary pads or tampons every hour for several hours in a row. Needing double sanitary protection to control your menstrual flow. Getting up at night to change sanitary pads or tampons. Bleeding for more than a week. Passing blood clots larger than a quarter. Limiting daily activities due to heavy menstrual flow. Feeling tired, fatigued or short of breath as the result of blood loss.

• #3 Heavy menstrual bleeding – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/menorrhagia/symptoms-causes/syc-20352829

  Adenomyosis. In this condition, glands from the lining of the uterus grow into the wall of the uterus itself. This can cause heavy bleeding and painful periods. […] Heavy menstrual bleeding can cause anemia related to blood loss. Anemia is a condition in which the body lacks enough red blood cells to carry oxygen to tissues. The number of red blood cells is measured by hemoglobin. Hemoglobin is a protein in red blood cells that carries oxygen to tissues throughout the body. […] Heavy menstrual bleeding may make iron levels too low. This may result in iron deficiency anemia. Symptoms include headaches and feeling tired. Although diet plays a role in iron deficiency anemia, the problem is made worse by heavy menstrual periods.

• #3 Menstrual disorders Information | Mount Sinai – New York

  https://www.mountsinai.org/health-library/report/menstrual-disorders

  Women who have menorrhagia (heavy bleeding) may get tests for bleeding disorders. If women are losing a lot of blood, they should also get tested for anemia. […] Your medical history can help a health care provider determine whether a menstrual problem is caused by another medical condition. […] A menstrual diary is a helpful way to keep track of changes in menstrual cycles. […] Imaging techniques are often used to detect certain conditions that may be causing menstrual disorders. […] When heavy or abnormal bleeding occurs, an endometrial (uterine) biopsy may be performed in a medical office. […] Hysteroscopy is a procedure that can detect the presence of fibroids, polyps, or other causes of bleeding. […] Hysterectomy is the surgical removal of the uterus. […] Heavy bleeding, often from fibroids, and pelvic pain are the reasons for many hysterectomies.

• #3 Heavy Periods – Ultrasound Scan – The Gynaecology Ultrasound Centre

  https://ultragyn.co.uk/ultrasound-scanning/heavy-periods/

  Heavy periods are common and can severely impact a women’s quality of life. […] An accurate diagnosis of the cause of menstrual problems is crucial to planning appropriate and effective treatment. Thankfully all these conditions can be diagnosed on ultrasound scans. […] This information can be used not only to determine whether the fibroids are the likely cause of women’s symptoms, but also to decide what type of treatment could be offered to women suffering with these periods. […] Using ultrasound, we can not only diagnose adenomyosis, but also see how severe it is, which correlates with the menstrual loss. This helps us determine how likely the adenomyosis is to be the cause of menstrual symptoms which helps to guide management.

• #3 Abnormal Uterine Bleeding in Premenopausal Women | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/0401/p435.html

  Abnormal uterine bleeding is a common symptom in women. The acronym PALM-COEIN facilitates classification, with PALM referring to structural etiologies (polyp, adenomyosis, leiomyoma, malignancy and hyperplasia), and COEIN referring to nonstructural etiologies (coagulopathy, ovulatory dysfunction, endometrial, iatrogenic, not otherwise classified). Evaluation involves a detailed history and pelvic examination, as well as laboratory testing that includes a pregnancy test and complete blood count. Endometrial sampling should be performed in patients 45 years and older, and in younger patients with a significant history of unopposed estrogen exposure. Transvaginal ultrasonography is the preferred imaging modality and is indicated if a structural etiology is suspected or if symptoms persist despite appropriate initial treatment. Medical and surgical treatment options are available. Hysterectomy is the definitive treatment. The most effective long-term medical treatment for heavy menstrual bleeding is the levonorgestrel-releasing intrauterine system. The acronym PALM-COEIN facilitates the classification of abnormal uterine bleeding, with PALM referring to structural etiologies (polyp, adenomyosis, leiomyoma, malignancy and hyperplasia), and COEIN referring to nonstructural etiologies (coagulopathy, ovulatory dysfunction, endometrial, iatrogenic, not otherwise classified). The 20-mcg-per-day formulation of the levonorgestrel-releasing intrauterine system (Mirena) is most effective for decreasing heavy menstrual bleeding (71% to 95% reduction in blood loss) and performs similarly to hysterectomy when quality-adjusted life years are considered. Heavy menstrual bleeding is defined as more than 80 mL of total blood loss, but quantitative assessment is impractical in routine clinical practice. Approximately 20% of patients with heavy menstrual bleeding have a bleeding disorder, and the prevalence in adolescent girls who bleed heavily is even higher. The most common causes of abnormal uterine bleeding are described with the acronym PALM-COEIN. The etiologies in the PALM group (polyp, adenomyosis, leiomyoma, malignancy and hyperplasia) are structural and can be imaged or biopsied. The etiologies in the COEIN group (coagulopathy, ovulatory dysfunction, endometrial, iatrogenic, not otherwise classified) are nonstructural.

• #3 Heavy menstrual bleeding diagnosis and medical management | Contraception and Reproductive Medicine | Full Text

  https://contraceptionmedicine.biomedcentral.com/articles/10.1186/s40834-017-0047-4

  The medical treatments include hormonal and non-hormonal options and the most effective in term of bleeding reduction are LNG-IUS, CHCs, tranexamic acid and long courses of oral progesterone. […] Although heavy menstrual bleeding is a common gynecological problem, there is a challenge in diagnosis and treatment as the condition cannot not be explained by a single hemostatic pathway.

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