Advertisement
Feature Article

Heavy menstrual bleeding. Treatment and referral options

Deborah Bateson, KIRSTEN I. BLACK

Figures

© saturn stills/spl model used for illustrative purposes only
© saturn stills/spl model used for illustrative purposes only

Abstract

Heavy menstrual bleeding affects about one in  four women. After excluding malignancy, first-line management in primary care is with pharmaceutical treatments. Other treatment options include endometrial ablation and hysterectomy.

Key Points

  • Heavy menstrual bleeding (HMB) affects about 25% of women of reproductive age.
  • Comprehensive assessment is essential to determine the likely cause of the bleeding and its impact on a woman’s life; it includes exclusion of anaemia, iron deficiency and reproductive tract cancer.
  • Many women with HMB of benign causes can be managed in general practice with pharmaceutical treatment including the levonorgestrel-releasing intrauterine system.
  • Less-invasive surgical options such as endometrial ablation are appropriate for some women.
  • Hysterectomy offers definitive treatment of HMB of benign causes when other treatment options have been ineffective or are unsuitable.

Figures

© saturn stills/spl model used for illustrative purposes only
© saturn stills/spl model used for illustrative purposes only