How I manage heavy menstrual bleeding

Abstract

SummaryHeavy menstrual bleeding (HMB) is a common clinical problem; population-based studies estimate that approximately 10-35% of women report this symptom during their lifetime, while about 5% of women consult a physician for evaluation of HMB. Patients with HMB account for 15% of all referrals to gynaecologists and are frequently seen by haematologists in bleeding disorder clinics as well. Heavy menstrual bleeding can be caused by a wide variety of local and systemic factors, so a careful clinical and laboratory evaluation is often necessary to determine the aetiology and guide appropriate management. This review discusses the definition, causes and clinical outcomes of HMB. It outlines a diagnostic approach and focuses on medical (as opposed to surgical) treatments. Throughout, areas of controversy and opportunities for further research are highlighted.

Challenging Aspects of Managing Hemostasis in Adolescents

“…In a recent study of health-related quality of life among 184 adolescents, 34% complained of heavy bleeding [24]. Population-based studies estimate that 10-35% of women report heavy menstrual bleeding, and physicians, including hematologists and gynecologists, may often be consulted regarding the etiology and the proper treatment of this symptom [25,26,27]. Objectively, heavy menstrual bleeding is defined as prolonged (over 7 days) and yields above 80 ml blood loss per menstrual cycle [27].…”

“…Objectively, heavy menstrual bleeding is defined as prolonged (over 7 days) and yields above 80 ml blood loss per menstrual cycle [27]. A detailed history and careful physical examination evaluating any skin signs of easy bruising, petechiae, purpura, dental or mucosal bleeds as well as a detailed family history regarding bleeding complications may lead to the diagnosis of inherited bleeding disorders [25]. As the validity and reproducibility of bleeding classification according to mucocutaneous bleeding questionnaires has not been fully elucidated for children and adolescents [28], efforts should be made to quantify bleeding and further assess laboratory parameters in order to accurately establish the diagnosis.…”

“…Initial laboratory testing should include a complete blood cell count, prothrombin time, partial thromboplastin time, levels of factor VIII (FVIII), von Willebrand factor (VWF) antigen, ristocetin cofactor and platelet function tests. Evaluation of multimers and detailed factor assays for rare bleeding disorders may be performed later, at the hematologist's discretion [25,29,32]. Naturally, laboratory assessments should be made at the time of menstrual bleeding in order to capture the nadir of the lowest documented levels of VWF antigen [27].…”

Pictorial methods to assess heavy menstrual bleeding in research and clinical practice: a systematic literature review

“…Heavy menstrual bleeding (HMB) is a common gynecological condition that adversely affects quality of life and work productivity. Approximately 10-35% of women report heavy menstrual periods at some stage during their reproductive years, with 5% consulting a medical practitioner for investigation of HMB [1]. In research, HMB is defined as a measured menstrual blood loss (MBL) of > 80 mL per cycle, but studies have repeatedly shown that at least 40% of women seeking medical attention for heavy periods lose less than this volume [2][3][4][5].…”

PBAC score: an easy‐to‐use tool to predict coagulation disorders in women with idiopathic heavy menstrual bleeding

“…Women with inherited bleeding disorders suffer significant morbidity and impaired quality-of-life associated with heavy menstrual-related bleeding [1]. Heavy menstrual bleeding (HMB), also referred to as menorrhagia, is defined as uterine bleeding that lasts for >7 days or blood loss >80 mL per menstrual cycle [2].…”