Heavy Menstrual Bleeding-NICE -A4Medicine

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Heavy Menstrual Bleeding-NICE -A4Medicine Heavy Menstrual Bleeding- assessment and management Evaluate impact- Heavy menstrual bleeding HMB is one of the commonest reason for gynecological referral and consultations About 1 in 20 women aged 30-49 yrs see GP/ year for HMB or menstrual problems Menstrual disorders comprise 
 12 of all referral to gynecology service The guideline states that HMB has a major impact on a wom e n ’s QOL and advises to ensure that any intervention should aim to improve this rather than focusing on blood loss HMB -a report has shown- 74 suffered anxiety 67 depression 62 reported impact on physical wellbeing

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History Examination and Testing – Nature of bleeding Related symptoms as 
 ○ persistent IMB 
 ○ pelvic pain and / or pressure symptoms 
 -may indicate uterine cavity abnormality 
 - histological abnormality 
 - adenomyosis or fibroids Impact on QOL Co-morbidities Previous treatment of HMB Take into account the range natural variability in menstrual cycles and blood loss when diagnosing HMB -discuss the variation. Discuss care options if the women feel she does not fall within the normal range. Physical examination HMB without other related symptoms – Consider pharmacological management without carrying out a physical examination. Undertake a physical examination- HMB with other related symptoms Before all investigations or LNG-IUS fittings Lab tests – FBC – for all with HMB in parallel with any HMB treatment offered 
 Coagulation disorders eg von W iller b ra nd’s disease if 
 ○ have had HMB since their periods started and 
 ○ have a personal or family hx suggestive of a coagulation disorder 
 TFT not routinely indicated unless other signs and symptoms of thyroid illness Investigating the cause –History and or examination suggests a low risk of fibroids uterine cavity abnormality histological abnormality or adenomyosis. Consider starting pharmacological 
 management without investigating the cause. Cancer suspected- USC. Take into account history and examination to decide which first line to offer. Outpatient hysteroscopy. If hx suggests 
 ○ submucosal fibroids 
 ○ polyps or 
 ○ endometrial pathology

 because they have

 ○ symptoms as persistent intermenstrual bleeding

 ○ risk factors for endometrial pathology. NICE clarifies further that these are women with

 - persistent intermenstrual or persistent irregular bleeding who are obese or have PCOS 
 - women who are on tamoxifen 
 - women for whom treatment for HMB has been unsuccessful 
 NICE has set-out guidance for organization and standards for the OP hysteroscopy services 
 NICE also contemplates that hysterocopy services could be offered by GPs 
 Women should be offered hysterocopy under general anesthesia if she declines OP hysteroscpy 
 If a women declines hysteroscopy- offer a pelvic US and explain the limitations of this technique for detecting uterine cavity causes of HMB.

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Visit: https://www.a4medicine.co.uk/heavy- menstrual-bleeding/

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