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Heavy menstrual bleeding
heavy menstrual bleeding (HMB) has a major impact on a woman's quality of life; any intervention aims to improve this rather than focusing on blood loss.
The term "normally heavy menstrual bleeding" refers to menstrual bleeding that is excessive in duration or intensity, affecting a woman's physical or psychological health, or her daily activities.
It is generally defined as bleeding that lasts more than 7 days or requires frequent sanitary pad changes, as every one to two hours.
There are many causes of heavy menstrual bleeding, including organic causes such as uterine fibroids, polyps, clotting disorders, and intrauterine devices (IUDs).
Hormonal causes are also common, especially before menopause. In some cases, the hormonal imbalance may be unexplained.
The patient may experience accompanying symptoms such as fatigue, dizziness, and iron-deficiency anemia, which can negatively impact her quality of life.
Diagnosis is based on medical history, physical examination, laboratory tests, and ultrasound.
Treatment depends on the underlying cause and ranges from medication to surgery.
Consider an LNG-IUS as the first treatment for HMB in women with:
• no identified pathology or
• fibroids less than 3 cm in diameter, which are not causing distortion of the uterine cavity or
• suspected or diagnosed adenomyosis
If a woman with HMB declines an LNG-IUS or it is not suitable, consider the following pharmacological treatments:
• non-hormonal:
－ tranexamic acid
－ NSAIDs (non-steroidal anti-inflammatory drugs)
• hormonal:
－ combined hormonal contraception
－ cyclical oral progestogens.
If treatment is unsuccessful, the woman declines pharmacological treatment, or symptoms are severe, she can be offered
surgical options:
- second-generation endometrial ablation
- hysterectomy
-For women with submucosal fibroids or polyps, consider hysteroscopic removal
Dr Najeeb Layyous F.R.C.O.G
Consultant Obstetrician, Gynecologist and Infertility Specialist
