Heavy menstrual bleeding-NICE

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 womens 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

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 feels 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...