Heavy menstrual bleeding

What is heavy menstrual bleeding?

Also referred to as menorrhagia or dysfunctional uterine bleeding (DUB), heavy menstrual bleeding (HMB) affects 25% of women during their reproductive years (ages 15-45).  It is the commonest reason for referral to a gynaecologist. 


Normal bleeding averages 40 ml per cycle. HMB is when the loss is over 80 ml. If a woman considers she has HMB she will often describe her symptoms as “I use double protection, I have to take time off work, I flood like a tap, I cannot wear white clothes, and I am drained all the time.”


It affects all aspects of a woman’s quality of life but over 70% of people wait up to a year before seeing a gynaecologist.


What causes heavy bleeding?

HMB may be associated with concurrent benign diseases such as fibroids, endometriosis and pelvic inflammatory disease.


For women over 45 years; the danger or ‘red alert’ features which may mean pelvic cancer include pain, irregular bleeding, intermenstrual bleeding or bleeding after sexual intercourse.  A history of PCOS, obesity or a family history of breast, colon or endometrial cancer may be indicators of pelvic cancer. However, do please remember pelvic cancer is rare.


How is heavy menstrual bleeding treated?

In approx 10% of patients, tests reveal no abnormality and the patient is happily reassured. The rest will need a range of treatment options which include progestogens, NSAIDS, tranexamic acid, antifibrinolytics and the oral contraceptive pill or a combination of these. Many would have already tried complementary treatments such as hypnosis, acupuncture and herbal preparations, which typically will help 50-60% of women.


If the above treatment options fail then the next option is to fit a mirena coil, which will cure 90% of cases. This can produce complete amenorrhoea (absence of menstruation) in 70% of cases. The main reason not to use this effective treatment is if you have not had children or contemplating a family in the near future.


For a woman over 35 years, whose family is complete or indeed does not want children the best surgical treatment is endometrial ablation or resection.  Mr Annan personally will not perform a hysterectomy for HMB, although a few women ask for this as a permanent cure.


Do you have any questions?

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