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Heavy menstrual bleeding: work-up and management.

Andra H James1

  • 1Department of Obstetrics and Gynecology, Duke University, Durham, NC.

Hematology. American Society of Hematology. Education Program
|December 4, 2016
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Summary
This summary is machine-generated.

Heavy menstrual bleeding (HMB) affects many women, often indicating underlying bleeding disorders or anticoagulation issues. Prompt diagnosis and tailored treatment, including hemostatic therapy, are crucial for managing HMB effectively.

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Area of Science:

  • Gynecology
  • Hematology
  • Internal Medicine

Background:

  • Heavy menstrual bleeding (HMB), also known as menorrhagia, is a common gynecological issue.
  • Approximately 90% of women with bleeding disorders and 70% of women on anticoagulation experience HMB.
  • Predictors of HMB include large clots, low ferritin levels, and frequent pad/tampon changes.

Purpose of the Study:

  • To outline the diagnostic work-up for HMB.
  • To identify potential causes of HMB, including uterine/endometrial factors, ovulatory dysfunction, or coagulation disorders.
  • To emphasize the importance of referral to a hematologist for suspected bleeding disorders.

Main Methods:

  • Patient history, including personal/family bleeding history.
  • Pelvic examination and/or imaging.
  • Laboratory assessment for anemia, ovulatory dysfunction, and bleeding disorders; anticoagulation assessment if applicable.

Main Results:

  • HMB with specific symptoms (flooding, prolonged menses, large clots) or bleeding history strongly suggests a bleeding disorder.
  • Evaluation aims to differentiate between uterine, ovulatory, and coagulation causes.
  • Treatment strategies are individualized based on the cause, patient age, and fertility desires.

Conclusions:

  • Accurate diagnosis of HMB requires a comprehensive evaluation.
  • Treatment options for HMB are diverse, ranging from hormonal/surgical to hemostatic therapy.
  • Hemostatic therapy can be a life-saving alternative for HMB due to coagulation abnormalities.