Heavy menstrual bleeding

One definition for diagnosing the condition is bleeding lasting more than 7 days or the loss of more than 80 mL of blood heavy flow.

[12] Furthermore, prostaglandins have been found to trigger abnormal, painful uterine contractions, making it a source for targeted therapy.

[13] Diagnosis is largely achieved by obtaining a complete medical history followed by physical exam and vaginal ultrasonography.

In the UK, the NICE guidelines states that: "Many women presenting to primary care with symptoms of HMB can be offered treatment without the need for further examination or investigation.

However, investigation via a diagnostic technique might be warranted for women for whom history or examination suggests a structural or endometrial pathology or for whom the initial treatment has failed.

If anemia occurs due to bleeding then iron tablets may be used to help restore normal hemoglobin levels.

[1] The first line treatment option for those with HMB and no identified pathology, fibroids less than 3 cm in diameter, and/or suspected or confirmed adenomyosis is the levonorgestrel-releasing intrauterine system (LNG-IUS).

"[16] Progestogen pills, independently if taken in a short or long course, are not as effective at reducing menstrual blood loss as LNG-IUS or tranexamic acid.

The risks of the procedure have been reduced with measures to minimize the risk of deep vein thrombosis after surgery, and the switch from the front abdominal to vaginal approach greatly minimizing the discomfort and recuperation time for the patient; however extensive fibroids may make the womb too large for removal by the vaginal approach.

[58] The effectiveness of endometrial ablation is probably similar to that of LNG‐IUS but the evidence is uncertain if hysterectomy is better or worse than LNG-IUS for improving HMB.

[70] This has a number of causes: better medical management, endometrial ablation and particularly the introduction of IUS[71][72] which may be inserted in the community and avoid the need for specialist referral; in one study up to 64% of women cancelled surgery.

[4] Symptoms attributable to the anemia may include shortness of breath, tiredness, weakness, tingling and numbness in fingers and toes, headaches, depression, becoming cold more easily, and poor concentration.

Symptoms of heavy menstrual bleeding, according to the decision aid from NHS England. [ 8 ]
Prevalence of heavy menstrual bleeding, amongst people of child-bearing age, and the proportion who seek medical help. [ 14 ]
Heavy Menstrual Bleeding - Treatment Workflow [ 19 ]
The treatment choices of those referred to hospital in the UK for heavy menstrual bleeding. [ 20 ]
The efficacy of different treatments for heavy menstrual bleeding. [ 29 ] [ 30 ] [ 31 ] [ 32 ] [ 33 ] [ 34 ] [ 35 ] [ 36 ] [ 37 ] [ 38 ] [ 39 ] [ 40 ] [ 41 ] [ 42 ] [ 43 ] [ 44 ] [ 45 ] [ 46 ] [ 47 ] [ 48 ] [ 49 ] [ 50 ] [ 51 ] [ 52 ] [ 53 ] [ 54 ] Graphic from NHS decision aid (purple colour indicates hormonal medications, pale green indicates surgical procedures). [ 8 ]
The side effects of surgical approaches to heavy menstrual bleeding. [ 55 ] [ 56 ] [ 40 ] [ 54 ] [ 57 ]
Side effects of medications used for heavy menstrual bleeding. [ 57 ] [ 41 ] [ 37 ] [ 38 ] [ 36 ] [ 33 ] [ 34 ] [ 59 ] [ 48 ] [ 29 ] [ 60 ] [ 61 ] [ 62 ]
The effects of long term hormonal medication use on cancer risks (in women of child-bearing age). [ 63 ]