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Heavy Menstrual Bleeding

Heavy Menstrual Bleeding. Heavy Menstrual Bleeding . Also called menorrhagia Excessive menstrual bleeding which interferes with a woman’s physical, social, emotional or material quality of life. Causes of Heavy Menstrual Bleeding. Bleeding disorders – rare

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Heavy Menstrual Bleeding

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  1. Heavy Menstrual Bleeding

  2. Heavy Menstrual Bleeding • Also called menorrhagia • Excessive menstrual bleeding which interferes with a woman’s physical, social, emotional or material quality of life

  3. Causes of Heavy Menstrual Bleeding Bleeding disorders – rare Endometrial Hyperplasia – early teens, 40s, throughout reproductive life in women with polycystic ovarian syndrome Fibroids Adenmyosis Endometrial Polyps Endometrial Cancer Dysfunctional uterine bleeding

  4. Age-related incidence of Cancer of the Endometrium

  5. History • Duration of problem • Cycle, duration of bleeding, intermenstrual bleeding • Impact on life • Type of protection used, how often changed, flooding, clots • Co-existing symptoms e.g. pain, symptoms of anaemia

  6. Examination • General –signs of anaemia, hypothyroidism,obesity, acne, hirsutism • Abdominal examination – is the uterus palpable? • Bimanual vaginal examination where appropriate, size of uterus, tenderness, mobility

  7. Investigations 1 • Screen for bleeding disorders such as Von Willebrand disease in women who have had heavy menses since menarche or with personal of family history to suggest a problem • Thyroid disease if history or physical exam suggestive • No evidence to support hormonal investigations

  8. Investigations 2 -Indications for Endometrial Biopsy • Co-existent intermenstrual bleeding • Heavy bleeding, prolonged bleeding in women over 40, no response to medical treatment • Look for endometrial hyperplasia or malignancy

  9. Investigations 3 -Ultrasound • Uterus palpable abdominally • Uterus enlarged on bimanual examination • Medical treatment has failed • Transvaginal U.S. usually more helpful • Fibroids, endometrial polyps, adenomyosis

  10. Investigations 4 -Indications for Hysteroscopy • To provide additional information on abnormality already inidicated on TVUS e.g. exact location of a polyp or fibroid.

  11. Possible Treatments for Heavy Menstrual Bleeding • Tranexamic Acid, NSAIDs • Combined pill, oral norethisterone day 6-26, injectable progestagens, levo-norgesterol device,GnRh Analogue • Fibroid embolisation, endometrial ablation • Myomectomy.vaginal hysterectomy, abdominal hysterectomy

  12. Hysterectomy for HMB • other treatment options have failed, are contraindicated or are declined by the woman • there is a wish for amenorrhoea • the woman (who has been fully informed) requests it • the woman no longer wishes to retain her uterus and fertility.

  13. Discussions prior to Hysterectomy • Complcations • Loss of fertility • Sexual feelings • Bladder function • Woman’s expectations • Need for further surgery • Pros and cons of oophorectomy

  14. GnRH Analogue • Prior to surgery • When all other treatments are contraindated • If used for over 6 months, then add-back HRT should be added

  15. Endometrial Ablation • Where medical treatments have failed, HMB is affecting quality of life, in a woman who does not wish to conceive in the future • Normal uterus or fibroids < 3mm diameter

  16. Transcervical resection of endometrium Radio-frequency ablation Thermal balloon ablation Microwave endometrial ablation Free fluid thermal ablation Endometrial Ablation

  17. Unwanted Effects of Treatment

  18. Unwanted Effects of Treatments

  19. Unwanted Effects of Treatments

  20. Unwanted Effects of Treatments

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