Materiały źródłowe

• #1 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. […] Your healthcare provider will ask a series of questions about your medical history and menstrual cycle to diagnose menorrhagia. Theyll also perform a physical exam and a pelvic exam. […] A pelvic ultrasound is the most common way healthcare providers diagnose menorrhagia. You may have other tests, depending on your age and how severe your symptoms are.

• #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

  Heavy menstrual bleeding (HMB) is a common gynecological problem that has a significant impact on a womans quality of life and the activities of daily living. […] The National Institute for Health and Care Excellence in the United Kingdom proposed a definition of HMB as an excessive menstrual blood loss that interferes with the womans physical, emotional, social and material quality of life and this can occur alone or in combination with other symptoms and with a menstrual blood loss of 80 mL. […] Measuring blood loss in clinical trials requires collecting all sanitary pads and tampons used during menstruation, and extracting the hemoglobin using the alkaline hematin method to estimate blood loss. […] Heavy menstrual bleeding is one of the most common gynecological problems, which accounts for 1830% of gynecologic visit and results in 17.8 surgical procedure per 10,000 reproductive age women in United States.

• #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

  Heavy menstrual bleeding (HMB) is a common gynecological problem that has a significant impact on a womans quality of life and the activities of daily living. […] The National Institute for Health and Care Excellence in the United Kingdom proposed a definition of HMB as an excessive menstrual blood loss that interferes with the womans physical, emotional, social and material quality of life and this can occur alone or in combination with other symptoms and with a menstrual blood loss of 80 mL. […] Measuring blood loss in clinical trials requires collecting all sanitary pads and tampons used during menstruation, and extracting the hemoglobin using the alkaline hematin method to estimate blood loss. […] Heavy menstrual bleeding is one of the most common gynecological problems, which accounts for 1830% of gynecologic visit and results in 17.8 surgical procedure per 10,000 reproductive age women in United States.

• #4 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. […] Your healthcare provider can determine if you might need testing for a possible bleeding disorder. […] 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. […] Your healthcare provider might tell you that one or more of the following tests will help find out if you have a bleeding problem: Blood test. […] If you have heavy menstrual bleeding and your gynecologist has not found any problems during your routine visit, you should be tested for a bleeding disorder.

• #5 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.

• #6 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.

• #7 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.

• #8 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.

• #9 Signs and Symptoms of Bleeding Disorders in Women | Bleeding Disorders in Women | CDC

  https://www.cdc.gov/female-blood-disorders/signs-symptoms/index.html

  Heavy bleeding during menstruation, anemia, and easy or frequent bleeding can be signs of a bleeding disorder in women. […] Heavy bleeding during menstruation (period) that can include […] Bleeding that lasts longer than 7 days from the time bleeding starts until the time it ends; […] Flooding or gushing of blood that limits daily activities, such as work, school, exercise, or social activities; […] Passing clots that are bigger than a grape; and […] Soaking a tampon or pad every hour or more often on the heaviest day(s). […] A diagnosis of „low in iron” or having received treatment for anemia. […] If you have one or more of these signs and symptoms, talk with your doctor or other healthcare professional. […] The Better You Know website has a bleeding disorder risk assessment, which will help you determine if you might have a bleeding disorder.

• #10 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.

• #11 Diagnosis of Heavy Menstrual Bleeding

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

  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). […] 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 SIS or gel infusion sonography (GIS) to visualize the uterine cavity. […] Saline infusion sonography/gel infusion sonography are reliable diagnostic procedures for excluding intracavitary abnormalities in women with HMB. […] Laboratory tests, endometrial sampling and MRI should only be performed when indicated.

• #12 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:

• #13 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 obstetriciangynecologist (ob-gyn). […] Any of the following can be a sign of heavy menstrual bleeding: […] 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. […] When you see your ob-gyn about heavy menstrual bleeding, you may be asked about […] your menstrual cycleIf you can, use a calendar or period-tracking smartphone app to keep track of your cycle before your visit. Your ob-gyn will want to know detailed information about several cycles, including the dates that your period started, how long bleeding lasted, and the amount of flow (light, medium, heavy, or spotting).

• #14 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 obstetriciangynecologist (ob-gyn). […] Any of the following can be a sign of heavy menstrual bleeding: […] 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. […] When you see your ob-gyn about heavy menstrual bleeding, you may be asked about […] your menstrual cycleIf you can, use a calendar or period-tracking smartphone app to keep track of your cycle before your visit. Your ob-gyn will want to know detailed information about several cycles, including the dates that your period started, how long bleeding lasted, and the amount of flow (light, medium, heavy, or spotting).

• #15 Abnormal Uterine Bleeding: Causes, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/menometrorrhagia-abnormal-uterine-bleeding

  Your healthcare provider will ask you several questions when working to diagnose abnormal uterine bleeding. These questions may include: What brings on the bleeding? How long do you bleed? How heavy is the bleeding? How often do you bleed? Do you track your menstrual cycles? What other symptoms do you have? What medicine, vitamins or supplements do you take? Is there a chance that youre pregnant? […] The most common steps your provider will do to diagnose the condition are: A pregnancy test. Light bleeding is also common in the early stages of pregnancy. Blood tests. Your provider can check how your blood clots and do a complete blood count (CBC). Hormone levels blood test. Hormone imbalances may be causing your abnormal bleeding, or they may be a sign of a condition causing your bleeding. A pelvic ultrasound. Imaging allows your provider to check for any growths in your reproductive organs that may be causing your bleeding. A sonohysterogram, also called saline-infusion sonography, is a highly sensitive imaging procedure that can help your provider identify abnormal structures in your uterus, like polyps or fibroids. […] Your treatment depends on whats causing your bleeding. Medications and surgical options are available to manage your bleeding or treat whats causing it.

• #16 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. […] If obstetriciangynecologists suspect that a patient has a bleeding disorder, they should work in coordination with a hematologist for laboratory evaluation and medical management. […] 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. […] Physical examination of the patient who presents with acute heavy menstrual bleeding should include assessment of hemodynamic stability, including orthostatic blood pressure and pulse measurements.

• #17 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. […] 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. […] 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.

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

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

  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. […] A physical examination should be performed by an appropriate healthcare professional when a patient presents with HMB accompanied by other related symptoms or when a levonorgestrel-releasing intrauterine system (LNG-IUS) is indicated for treatment. A full blood count should always be performed. In addition, a thyroid-stimulating hormone test, serum-free testosterone and a prothrombin time/activated partial thromboplastin time test could be informative depending on the symptoms identified while history-taking or during the physical examination. Testing for coagulation disorders may be indicated when patients have had HMB since the onset of their menstruation or if there is a family history of such disorders.

• #19 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. […] These studies are used to rule out von Willebrand disease; ITP; and factor II, V, VII, or IX deficiency. […] Pregnancy remains the most common cause of abnormal uterine bleeding in patients of reproductive age. […] These tests can rule out hyperthyroidism, hypothyroidism, and hyperprolactinemia. […] Order liver function tests (LFTs) when liver disease is suspected, such as in persons with alcoholism or hepatitis. […] Total testosterone and sex hormone-binding globulin or free testosterone can assist in diagnosing biochemical hyperandrogenemia in those with suspected PCOS. […] Papanicolaou (Pap) smear test results for cervical cytology should be current. […] Endometrial biopsy most typically samples an approximate 10% of the uterine lining.

• #20 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.

• #21 Azthena logo with the word Azthena

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

  The work up for Menorrhagia includes complete and routine blood tests. These include test for haemoglobin. 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.

• #22 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 coagulopathy (AUB-C) cause of HMB includes systemic disorders of hemostasis or coagulopathies. […] Approximately 90% of AUB-C could be identified as a coagulopathy with use of the structured history screening criteria. […] A normal menstrual cycle has an average duration of menstrual bleeding of 4.58 days an interval of 2438 days between the onsets of menses with 220 days of cycle to cycle variation over 12 months. […] Several different pathways that result or cause hemostatic dysfunctions have been implicated in increased menstrual blood loss. […] The multiple pathways include the fibrinolytic system represented by plasminogen activator and its inhibitor, increased prostaglandinE2, local cytokines, and the influx of leukocytes into the endometrial stroma. […] No single pathway explains the cause of HMB.

• #23 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. […] These studies are used to rule out von Willebrand disease; ITP; and factor II, V, VII, or IX deficiency. […] Pregnancy remains the most common cause of abnormal uterine bleeding in patients of reproductive age. […] These tests can rule out hyperthyroidism, hypothyroidism, and hyperprolactinemia. […] Order liver function tests (LFTs) when liver disease is suspected, such as in persons with alcoholism or hepatitis. […] Total testosterone and sex hormone-binding globulin or free testosterone can assist in diagnosing biochemical hyperandrogenemia in those with suspected PCOS. […] Papanicolaou (Pap) smear test results for cervical cytology should be current. […] Endometrial biopsy most typically samples an approximate 10% of the uterine lining.

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

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

  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. […] Although testing appears to be most sensitive during menstruation when coagulation factor levels, most notably VWF and FVIII, are potentially at their lowest, testing should not be delayed to coincide with menstruation, but repeat testing during menses should be considered if initial VWF levels are at the lower limit of normal. […] 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. […] Hemostatic therapy for HMB may serve as an alternative to hormonal or surgical therapy, or be used to correct a coagulation defect. In women who have failed hormonal therapy and desire to preserve fertility, hemostatic therapy is the next step in treatment.

• #25 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 coagulopathy (AUB-C) cause of HMB includes systemic disorders of hemostasis or coagulopathies. […] Approximately 90% of AUB-C could be identified as a coagulopathy with use of the structured history screening criteria. […] A normal menstrual cycle has an average duration of menstrual bleeding of 4.58 days an interval of 2438 days between the onsets of menses with 220 days of cycle to cycle variation over 12 months. […] Several different pathways that result or cause hemostatic dysfunctions have been implicated in increased menstrual blood loss. […] The multiple pathways include the fibrinolytic system represented by plasminogen activator and its inhibitor, increased prostaglandinE2, local cytokines, and the influx of leukocytes into the endometrial stroma. […] No single pathway explains the cause of HMB.

• #26 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. […] 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. […] Transvaginal ultrasonography or saline infusion sonohysterography may be used to evaluate menorrhagia. […] When clear structural causes are identified or medical management is ineffective, polypectomy, fibroidectomy, uterine artery embolization, and endometrial ablation may be considered.

• #27 Bleeding Disorders That Cause HMB – Your Period

  https://www.yourperiod.ca/abnormal-pain-and-menstrual-bleeding/heavy-menstrual-bleeding/bleeding-disorders-that-cause-heavy-menstrual-bleeding/

  Regulation of menstrual flow also depends on the ability of your blood to clot properly. There are bleeding disorders (familial and not) that can cause HMB. Most bleeding disorders are acquired, as opposed to genetic. […] The most common symptom of von Willebrand disease in women is heavy menstrual bleeding. This includes having periods lasting more than seven days, with sufficiently heavy blood flow that daily activities are difficult to accomplish. On the heaviest bleeding days, it is common to soak through a tampon or pad every hour. […] A variety of tests are needed to diagnose von Willebrand disease. First, your doctor will collect information about your medical history and the bleeding problems you have experienced. Blood tests measuring von Willebrand factor and other clotting factors will likely be recommended, usually in specialised centers.

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

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

  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. […] Although testing appears to be most sensitive during menstruation when coagulation factor levels, most notably VWF and FVIII, are potentially at their lowest, testing should not be delayed to coincide with menstruation, but repeat testing during menses should be considered if initial VWF levels are at the lower limit of normal. […] 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. […] Hemostatic therapy for HMB may serve as an alternative to hormonal or surgical therapy, or be used to correct a coagulation defect. In women who have failed hormonal therapy and desire to preserve fertility, hemostatic therapy is the next step in treatment.

• #29 Diagnosis of Heavy Menstrual Bleeding

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

  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). […] 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 SIS or gel infusion sonography (GIS) to visualize the uterine cavity. […] Saline infusion sonography/gel infusion sonography are reliable diagnostic procedures for excluding intracavitary abnormalities in women with HMB. […] Laboratory tests, endometrial sampling and MRI should only be performed when indicated.

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

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

  Pelvic ultrasound is a noninvasive imaging study to assess uterine shape, size, and contour; endometrial thickness; and adnexal areas. […] This procedure is used in women who are at risk for endometrial polyps, hyperplasia, or carcinoma, though other pathology may be found. […] Understanding EMB results is essential for any physician treating menorrhagia. […] 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.

• #31 Abnormal Uterine Bleeding in Premenopausal Women | AAFP

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

  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). […] All patients with abnormal uterine bleeding should be tested for pregnancy and anemia. […] Endometrial biopsy should be performed in all patients with abnormal uterine bleeding who are 45 years or older, in younger patients with a significant history of unopposed estrogen exposure, persistent bleeding, or in whom medical management is ineffective. […] Transvaginal ultrasonography is the first-line imaging choice for evaluating abnormal uterine bleeding in most patients.

• #32 Abnormal Uterine Bleeding in Premenopausal Women | AAFP

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

  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). […] All patients with abnormal uterine bleeding should be tested for pregnancy and anemia. […] Endometrial biopsy should be performed in all patients with abnormal uterine bleeding who are 45 years or older, in younger patients with a significant history of unopposed estrogen exposure, persistent bleeding, or in whom medical management is ineffective. […] Transvaginal ultrasonography is the first-line imaging choice for evaluating abnormal uterine bleeding in most patients.

• #33 Abnormal Uterine Bleeding in Premenopausal Women | AAFP

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

  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). […] All patients with abnormal uterine bleeding should be tested for pregnancy and anemia. […] Endometrial biopsy should be performed in all patients with abnormal uterine bleeding who are 45 years or older, in younger patients with a significant history of unopposed estrogen exposure, persistent bleeding, or in whom medical management is ineffective. […] Transvaginal ultrasonography is the first-line imaging choice for evaluating abnormal uterine bleeding in most patients.

• #34 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:

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

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

  Hysterectomy is the most definitive treatment. […] Abnormal uterine bleeding occurs in 9 to 14 percent of women between menarche and menopause, significantly impacting quality of life and imposing financial burden. […] A normal cycle starts when pituitary follicle-stimulating hormone induces ovarian follicles to produce estrogen. […] Disruption of normal physiology, anatomic changes in the endometrium, or endometrial cancer may result in abnormal uterine bleeding. […] Adolescents with excessive uterine bleeding should be evaluated for bleeding disorders, such as von Willebrand disease. […] Saline infusion sonohysterography is more sensitive and specific for the detection of endometrial abnormalities than transvaginal ultrasonography. […] The levonorgestrel-releasing intrauterine system (Mirena) is an effective treatment for menorrhagia, with patient satisfaction scores similar to endometrial ablation and hysterectomy.

• #36 Diagnosis of Heavy Menstrual Bleeding

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

  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). […] 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 SIS or gel infusion sonography (GIS) to visualize the uterine cavity. […] Saline infusion sonography/gel infusion sonography are reliable diagnostic procedures for excluding intracavitary abnormalities in women with HMB. […] Laboratory tests, endometrial sampling and MRI should only be performed when indicated.

• #37 Diagnosis of Heavy Menstrual Bleeding

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

  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). […] 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 SIS or gel infusion sonography (GIS) to visualize the uterine cavity. […] Saline infusion sonography/gel infusion sonography are reliable diagnostic procedures for excluding intracavitary abnormalities in women with HMB. […] Laboratory tests, endometrial sampling and MRI should only be performed when indicated.

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

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

  In rare cases, advanced imaging methods such as MRI are used. MRI is very useful for clearly identifying adenomyosis or suspicious masses. Doctors usually recommend this method when other tests are inconclusive. […] Laboratory Tests 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. […] All of these tests help determine the exact cause of menorrhagia. Through a comprehensive evaluation, a personalized treatment plan is created for the patient. […] Methods Used for the Treatment of Excessive Menstruation […] Drug Treatments Drug treatments are the first choice for menorrhagia management. Treatment is shaped according to the severity of bleeding, the cause, and the patient’s lifestyle. Hormonal drugs regulate the menstrual cycle and control endometrial thickening. Birth control pills balance this process with their estrogen-progesterone content. In some cases, a hormonal IUD offers a long-term solution. This device is placed directly into the uterus and reduces the amount of bleeding.

• #39 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. […] Pelvic ultrasound can help in the diagnosis of abnormal menstrual bleeding, and can be used to view the lining of the uterus. […] 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.

• #40 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. […] Pelvic ultrasound can help in the diagnosis of abnormal menstrual bleeding, and can be used to view the lining of the uterus. […] 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.

• #41 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:

• #42 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. […] Pelvic ultrasound is conducted to detect fibroids, polyps etc. Hysteroscopy is used to directly visualize the uterine cavity. […] 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. The physician dilates the cervix and then inserts a spoon-shaped instrument called the curette into the uterus to collect tissues. The tissues are then examined under the microscope.

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

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

  If no abnormalities are found, hysteroscopy should be considered. […] There is little consensus on specific treatment regimens for anovulatory uterine bleeding. […] ACOG recommends treatment with combination oral contraceptives or cyclic progestin. […] Progestin therapy and oral contraceptives induce routine withdrawal bleeding, decrease the risk of hyperplasia or cancer, and correct any related excessive menstrual bleeding. […] Treatment options for women who have hyperplasia without atypia include cyclic medroxyprogesterone acetate at 10 mg per day for 14 days per month, continuous megestrol (Megace) at 40 mg per day, or the levonorgestrel-releasing intrauterine system (Mirena). […] Hysterectomy is the recommended treatment, but women desiring continued fertility may be candidates for progestin therapy and close follow-up.

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

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

  If no abnormalities are found, hysteroscopy should be considered. […] There is little consensus on specific treatment regimens for anovulatory uterine bleeding. […] ACOG recommends treatment with combination oral contraceptives or cyclic progestin. […] Progestin therapy and oral contraceptives induce routine withdrawal bleeding, decrease the risk of hyperplasia or cancer, and correct any related excessive menstrual bleeding. […] Treatment options for women who have hyperplasia without atypia include cyclic medroxyprogesterone acetate at 10 mg per day for 14 days per month, continuous megestrol (Megace) at 40 mg per day, or the levonorgestrel-releasing intrauterine system (Mirena). […] Hysterectomy is the recommended treatment, but women desiring continued fertility may be candidates for progestin therapy and close follow-up.

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

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

  Blood tests. A sample of your blood may be tested for iron deficiency anemia. The sample also may be tested for other conditions, such as thyroid disorders or blood-clotting problems. […] Pap test. In this test, cells from your cervix are collected. They are tested for inflammation or changes that may be precancerous, which means they could lead to cancer. Cells also are tested for human papilloma virus in women ages 25 to 30 and older. […] Endometrial biopsy. Your doctor may take a tissue sample from the inside of your uterus. A pathologist will look for signs of cancer or precancer of the uterus. […] Ultrasound. This imaging method uses sound waves to create pictures of your uterus, ovaries and pelvis. […] 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.

• #46 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. […] These studies are used to rule out von Willebrand disease; ITP; and factor II, V, VII, or IX deficiency. […] Pregnancy remains the most common cause of abnormal uterine bleeding in patients of reproductive age. […] These tests can rule out hyperthyroidism, hypothyroidism, and hyperprolactinemia. […] Order liver function tests (LFTs) when liver disease is suspected, such as in persons with alcoholism or hepatitis. […] Total testosterone and sex hormone-binding globulin or free testosterone can assist in diagnosing biochemical hyperandrogenemia in those with suspected PCOS. […] Papanicolaou (Pap) smear test results for cervical cytology should be current. […] Endometrial biopsy most typically samples an approximate 10% of the uterine lining.

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

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

  ACOG recommends endometrial tissue assessment to rule out cancer in adolescents and in women younger than 35 years with prolonged unopposed estrogen stimulation, women 35 years or older with suspected anovulatory bleeding, and women unresponsive to medical therapy. […] Findings may include benign endometrium, simple or complex hyperplasia without atypia, hyperplasia with atypia, or endometrial adenocarcinoma. […] In premenopausal women, endometrial biopsy is 82.3 percent sensitive for detecting hyperplasia with atypia and 91 percent sensitive for detecting endometrial cancer; specificity is 98 percent for both. […] 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.

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

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

  ACOG recommends endometrial tissue assessment to rule out cancer in adolescents and in women younger than 35 years with prolonged unopposed estrogen stimulation, women 35 years or older with suspected anovulatory bleeding, and women unresponsive to medical therapy. […] Findings may include benign endometrium, simple or complex hyperplasia without atypia, hyperplasia with atypia, or endometrial adenocarcinoma. […] In premenopausal women, endometrial biopsy is 82.3 percent sensitive for detecting hyperplasia with atypia and 91 percent sensitive for detecting endometrial cancer; specificity is 98 percent for both. […] 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.

• #49 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. […] Pelvic ultrasound is conducted to detect fibroids, polyps etc. Hysteroscopy is used to directly visualize the uterine cavity. […] 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. The physician dilates the cervix and then inserts a spoon-shaped instrument called the curette into the uterus to collect tissues. The tissues are then examined under the microscope.

• #50 Menorrhagia / Heavy Menstrual Bleeding / Heavy Periods – Diagnosis

  https://www.medindia.net/health/conditions/menorrhagia-diagnosis.htm

  The cause of menorrhagia is diagnosed using blood tests and procedures such as ultrasonography, hysteroscopy and dilatation and curettage. […] Tests that are useful to detect the cause of menorrhagia include: […] A complete blood count should be done to detect if the patient has anemia, infection or less platelets. The patients ferritin level as well as level of clotting factors may also need to be assessed. Thyroid, liver and kidney function tests as well as estimation of prolactin levels may be needed to rule out to rule out associated diseases. […] An ultrasound of the uterus may be done to detect any abnormalities such as a fibroid that may cause distortion or enlargement of the uterus. […] Hysteroscopy is a procedure where the inner lining of the uterus can be directly visualized by using an instrument called a hysteroscope inserted through the vagina. […] The gynecologist may dilate the cervix and take a small sample of the inner lining of the uterus. This sample is then subjected to further testing to detect any abnormality.

• #51 Dilatation & curettage for heavy menstrual bleeding – EBI

  https://ebi.aomrc.org.uk/interventions/dilatation-curettage-for-heavy-menstrual-bleeding/

  Dilation and curettage (DC) is a minor surgical procedure where the opening of the womb (cervix) is widened (dilatation) and the lining of the womb is scraped out (curettage). […] DC should not be used for diagnosis or treatment for heavy menstrual bleeding because it is clinically ineffective. […] Ultrasound scans and camera tests with sampling of the lining of the womb (hysteroscopy and biopsy) can be used to investigate heavy periods. […] NICE guidelines recommend that DC is not offered as a treatment option for heavy menstrual bleeding. There is very little evidence to suggest that DC works to treat heavy periods and the one study identified by NICE showed the effects were only temporary. DC should not be used to investigate heavy menstrual bleeding as hysteroscopy and biopsy work better. […] There are no diagnostic or treatment benefits with dilation and curettage. […] A doctor will usually use an ultrasound scan or an instrument which takes a small sample of the lining of your womb to see whats causing your heavy periods.

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

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

  Blood tests. A sample of your blood may be tested for iron deficiency anemia. The sample also may be tested for other conditions, such as thyroid disorders or blood-clotting problems. […] Pap test. In this test, cells from your cervix are collected. They are tested for inflammation or changes that may be precancerous, which means they could lead to cancer. Cells also are tested for human papilloma virus in women ages 25 to 30 and older. […] Endometrial biopsy. Your doctor may take a tissue sample from the inside of your uterus. A pathologist will look for signs of cancer or precancer of the uterus. […] Ultrasound. This imaging method uses sound waves to create pictures of your uterus, ovaries and pelvis. […] 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.

• #53 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. […] These studies are used to rule out von Willebrand disease; ITP; and factor II, V, VII, or IX deficiency. […] Pregnancy remains the most common cause of abnormal uterine bleeding in patients of reproductive age. […] These tests can rule out hyperthyroidism, hypothyroidism, and hyperprolactinemia. […] Order liver function tests (LFTs) when liver disease is suspected, such as in persons with alcoholism or hepatitis. […] Total testosterone and sex hormone-binding globulin or free testosterone can assist in diagnosing biochemical hyperandrogenemia in those with suspected PCOS. […] Papanicolaou (Pap) smear test results for cervical cytology should be current. […] Endometrial biopsy most typically samples an approximate 10% of the uterine lining.

• #54 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. […] These studies are used to rule out von Willebrand disease; ITP; and factor II, V, VII, or IX deficiency. […] Pregnancy remains the most common cause of abnormal uterine bleeding in patients of reproductive age. […] These tests can rule out hyperthyroidism, hypothyroidism, and hyperprolactinemia. […] Order liver function tests (LFTs) when liver disease is suspected, such as in persons with alcoholism or hepatitis. […] Total testosterone and sex hormone-binding globulin or free testosterone can assist in diagnosing biochemical hyperandrogenemia in those with suspected PCOS. […] Papanicolaou (Pap) smear test results for cervical cytology should be current. […] Endometrial biopsy most typically samples an approximate 10% of the uterine lining.

• #55 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.

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

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

  HMB could be treated with both medical and surgical interventions and both methods are safe, acceptable and effective. […] 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. […] Polyps, adenomyosis and leiomyoma are common structural abnormalities of the uterus, which are associated with abnormal bleeding. […] Pelvic ultrasonography is an initial method to identify structural abnormalities related to bleeding both intracavity lesion and adnexal lesion such as arteriovenous malformation.

• #57 Abnormal Uterine Bleeding in Premenopausal Women | AAFP

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

  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). […] All patients with abnormal uterine bleeding should be tested for pregnancy and anemia. […] Endometrial biopsy should be performed in all patients with abnormal uterine bleeding who are 45 years or older, in younger patients with a significant history of unopposed estrogen exposure, persistent bleeding, or in whom medical management is ineffective. […] Transvaginal ultrasonography is the first-line imaging choice for evaluating abnormal uterine bleeding in most patients.

• #58 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).

• #59 Menorrhagia: Practice Essentials, Background, Pathophysiology

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

  An international expert panel including obstetrician/gynecologists and hematologists has issued guidelines to assist physicians in better recognizing bleeding disorders, such as von Willebrand disease, as a cause of menorrhagia and postpartum hemorrhage and to provide disease-specific therapy for the bleeding disorder. […] The panel provided expert consensus recommendations on how to identify, confirm, and manage a bleeding disorder. An underlying 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 oral cavity or gastrointestinal tract without obvious lesion; and/or (3) epistaxis greater than 10 minutes duration (possibly necessitating packing or cautery).

• #60 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.

• #61 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. […] 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. […] 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.

• #62 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.

• #63 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. […] 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. […] 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.

• #64 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.

• #65 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.

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

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

  According to NICE, the recommended first-line treatment is a LNG-IUS if long-term management (≥12 months) is expected. A LNG-IUS (a progestogen) inhibits the endometrial synthesis of oestrogen, therefore preventing proliferation and, sometimes, ovulation. It may take at least six cycles to see the maximal benefits and, during this time, there can be changes in bleeding patterns that can last longer than six months. After one year of use, a LNG-IUS has been shown to decrease menstrual blood loss by up to 96%. […] Recommended second-line treatment includes tranexamic acid, non-steroidal anti-inflammatory drugs (NSAIDs) and combined oral contraceptives (COCs). Tranexamic acid is an antifibrinolytic — a potent inhibitor of the activation of plasminogen to plasmin — which inhibits fibrinolysis, increases clot formation and reduces blood loss by up to 58%. The anti-inflammatory activity of NSAIDs and their inhibitory actions on PGs reduces bleeding by 49%. COCs contain both oestrogen and progesterone, and have been estimated to reduce blood loss by up to 50%.

• #67 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 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. […] 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.

• #68 Heavy Menstrual Bleeding | ACOG

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

  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). Based on your symptoms and your age, additional tests may be needed: […] Medications often are tried first to treat 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. Pregnancy is not likely after ablation, but it can happen. If it does, the risk of serious complications is greatly increased. You will need to use a birth control method until after menopause following endometrial ablation. […] 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.

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

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

  Norethisterone is the recommended third-line treatment. It prevents the proliferation of the endometrium and reduces blood loss by up to 83%. In the event of initial treatment failure, a combination of non-hormonal treatment and one hormonal treatment can be trialled prior to specialist referral. […] It is important for pharmacists and other healthcare professionals to be aware of cultural, social and educational backgrounds of patients that present with HMB to ensure that the best quality of care is offered and that informed decisions are always made. A wide range of treatments (including OTC options) for HMB or menorrhagia is available in pharmacies. Effective history-taking is key for effective management, as is identification of patients requiring urgent referral. Women seeking advice from pharmacists about HMB should be given evidence-based information and be actively involved in treatment decisions.

• #70 Heavy Menstrual Bleeding | ACOG

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

  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). Based on your symptoms and your age, additional tests may be needed: […] Medications often are tried first to treat 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. Pregnancy is not likely after ablation, but it can happen. If it does, the risk of serious complications is greatly increased. You will need to use a birth control method until after menopause following endometrial ablation. […] 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.

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

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

  Women found to have adenocarcinoma should be referred to a gynecologic oncologist for hysterectomy and staging. […] The goals of treatment for menorrhagia are to reduce flow volume and to correct anemia. […] Hormonal and non-hormonal therapeutic options are available to patients. […] Progestins effectively decrease excessive menstrual bleeding. […] The continuous progesterone release provided by the levonorgestrel-releasing intrauterine system reduces menorrhagia more effectively than oral progestins. […] Tranexamic acid (Lysteda), an antifibrinolytic that prevents activation of plasminogen, is FDA-approved for the treatment of menorrhagia. […] If excessive uterine bleeding is unresponsive to medical intervention, endometrial ablation (the surgical destruction of the endometrium) may be considered. […] Hysterectomy is the definitive treatment for excessive uterine bleeding in women who no longer wish to conceive.

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

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

  Women found to have adenocarcinoma should be referred to a gynecologic oncologist for hysterectomy and staging. […] The goals of treatment for menorrhagia are to reduce flow volume and to correct anemia. […] Hormonal and non-hormonal therapeutic options are available to patients. […] Progestins effectively decrease excessive menstrual bleeding. […] The continuous progesterone release provided by the levonorgestrel-releasing intrauterine system reduces menorrhagia more effectively than oral progestins. […] Tranexamic acid (Lysteda), an antifibrinolytic that prevents activation of plasminogen, is FDA-approved for the treatment of menorrhagia. […] If excessive uterine bleeding is unresponsive to medical intervention, endometrial ablation (the surgical destruction of the endometrium) may be considered. […] Hysterectomy is the definitive treatment for excessive uterine bleeding in women who no longer wish to conceive.

• #73 Heavy Menstrual Bleeding | ACOG

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

  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). Based on your symptoms and your age, additional tests may be needed: […] Medications often are tried first to treat 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. Pregnancy is not likely after ablation, but it can happen. If it does, the risk of serious complications is greatly increased. You will need to use a birth control method until after menopause following endometrial ablation. […] 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.

• #74 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

  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. […] Use of antifibrinolytics such as tranexamic acid or aminocaproic acid in oral and intravenous form may be used to stop 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. […] In the absence of contraindications to estrogen, hormonal therapy for acute heavy menstrual bleeding can consist of intravenous conjugated estrogen every 46 hours; alternatively, monophasic combined oral contraceptive pills (OCPs) (in 3050 microgram ethinyl estradiol formulation) can be used every 68 hours until cessation of bleeding.

• #75 Non-Pregnant Vaginal Bleeding: Differential Diagnosis, Presentation, Evaluation, and Management – emDocs

  https://www.emdocs.net/non-pregnant-vaginal-bleeding-differential-diagnosis-presentation-evaluation-and-management/

  Common causes of abnormal uterine bleeding can also be age dependent: […] Obtain a urine pregnancy test early in all patients who present with vaginal bleeding. […] If the patient appears unstable, begin resuscitation with fluids and blood products per for a goal mean arterial pressure (MAP) of 60-65mmHg. […] Oral contraceptive pills (OCPs), NSAIDs, and oral TXA are the most common medications used in the treatment of stable vaginal bleeding. […] If the patient appears unstable, consult gynecology immediately while stabilization is ongoing. […] If the patient appears stable, they can be safely discharged home with close gynecology follow-up.

• #76 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

  After correction of acute heavy menstrual bleeding, maintenance hormonal therapy can include combined hormonal contraceptives, oral and injectable progestins, and levonorgestrel-releasing intrauterine devices (LNG-IUDs). […] 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. […] Adolescents in whom a bleeding disorder has been diagnosed should be reminded that products that prevent platelet adhesion, such as aspirin or nonsteroidal antiinflammatory drugs, should be used only with the recommendation of a hematologist. […] In adolescents with known bleeding disorders, preoperative surgical evaluation, choice of hemostatic agents for control of intraoperative blood loss, and need for blood products should be determined in conjunction with a hematologist and an anesthesiologist.

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

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

  Treatment depends on whats causing your bleeding, how severe your bleeding is, your health, age and medical history. […] If medication doesnt improve your symptoms, your provider may recommend a surgical procedure. The type of procedure they recommend depends on the cause of your bleeding. […] Heavy bleeding can lead to anemia, which can be serious. If you think you have menorrhagia, its important to see a healthcare provider to treat it. […] You cant prevent all causes of heavy period bleeding. But talking with your healthcare provider to get a diagnosis and treatment can help you manage your bleeding so that it doesnt interfere with your quality of life. […] Left untreated, heavy periods can interfere with your life. In addition, heavy menstrual bleeding can cause anemia and leave you feeling tired and weak. Other health problems can also arise if you dont get help. With proper treatment and assistance from your provider, you can manage heavy periods without compromising your well-being.

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

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

  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. […] A physical examination should be performed by an appropriate healthcare professional when a patient presents with HMB accompanied by other related symptoms or when a levonorgestrel-releasing intrauterine system (LNG-IUS) is indicated for treatment. A full blood count should always be performed. In addition, a thyroid-stimulating hormone test, serum-free testosterone and a prothrombin time/activated partial thromboplastin time test could be informative depending on the symptoms identified while history-taking or during the physical examination. Testing for coagulation disorders may be indicated when patients have had HMB since the onset of their menstruation or if there is a family history of such disorders.

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

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

  Treatment depends on whats causing your bleeding, how severe your bleeding is, your health, age and medical history. […] If medication doesnt improve your symptoms, your provider may recommend a surgical procedure. The type of procedure they recommend depends on the cause of your bleeding. […] Heavy bleeding can lead to anemia, which can be serious. If you think you have menorrhagia, its important to see a healthcare provider to treat it. […] You cant prevent all causes of heavy period bleeding. But talking with your healthcare provider to get a diagnosis and treatment can help you manage your bleeding so that it doesnt interfere with your quality of life. […] Left untreated, heavy periods can interfere with your life. In addition, heavy menstrual bleeding can cause anemia and leave you feeling tired and weak. Other health problems can also arise if you dont get help. With proper treatment and assistance from your provider, you can manage heavy periods without compromising your well-being.

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

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

  Norethisterone is the recommended third-line treatment. It prevents the proliferation of the endometrium and reduces blood loss by up to 83%. In the event of initial treatment failure, a combination of non-hormonal treatment and one hormonal treatment can be trialled prior to specialist referral. […] It is important for pharmacists and other healthcare professionals to be aware of cultural, social and educational backgrounds of patients that present with HMB to ensure that the best quality of care is offered and that informed decisions are always made. A wide range of treatments (including OTC options) for HMB or menorrhagia is available in pharmacies. Effective history-taking is key for effective management, as is identification of patients requiring urgent referral. Women seeking advice from pharmacists about HMB should be given evidence-based information and be actively involved in treatment decisions.

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