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J Clin Outcomes Manage
2010 Dec;17(12):565-575
Management strategies for heavy menstrual bleeding
Borgatta L, Romcari D
Abstract: Objective: To provide a review of the causes, impact, and treatment options for heavy menstrual bleeding. Methods: Case presentation and review of the literature. Results: Heavy menstrual bleeding is common in reproductive-aged women. It can occur from the time of menarche until menopause. In the United States, heavy menstrual bleeding is often defined in a research setting as bleeding more than 80 mL during 1 period. Actual measurement of bleeding is impractical and unnecessary, as some women will have symptoms of heavy bleeding at lesser amounts. Functionally, heavy bleeding warranting investigation is determined by the woman’s symptoms and concerns. Interference with work or social situations and associated symptoms such as pain and fatigue are important. The woman’s assessment of her bleeding should guide her care. The most common causes of heavy menstrual bleeding are idiopathic bleeding, with an ovulatory pattern and an apparently normal uterus, anovulatory bleeding, disorders of hemostasis, and local lesions of the uterus such as polyps and fibroids. Diagnostic tests included hematology and coagulation tests, tests for underlying medical illnesses where appropriate, endometrial sampling, pelvic ultrasound, sonohysterogram, and hysteroscopy. Treatments for heavy menstrual bleeding include hormonal regulation or suppression of menses, nonsteroidal anti-inflammatory drugs, antifibrinolytic drugs, levonorgestrel-containing intrauterine devices, and endometrial de-struction. If a local anatomic lesion exists, resection of the lesion, usually via hysteroscopy, can correct the situation. However, some treatments may have side effects of irregular bleeding or amenorrhea, which may not be acceptable to some women. Conclusion: Heavy menstrual bleeding is a common condition. The severity of symptoms is frequently best assessed by the woman. A variety of medical and surgical approaches are available.
Case-Based Review
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