Algorithm for the Management of Heavy Menstrual Bleeding

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  • 8/16/2019 Algorithm for the Management of Heavy Menstrual Bleeding

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    Women reporting with heavy menstrual bleeding

    Full menstrual history . Examination . Full bloodcount

    ProlongedIrregular

    cycles

    Anaemic

    Referspecialist

    Abnormalexam

    uterine si e

    ! "# w$s

    %reatanaemia

    Yes

    No

    Yes

    severeNo Mild or

    moderate

    (80-115g/l)

    < 80 g/l

    Algorithm for the &anagement of 'eavy&enstrual (leeding

    No

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    Assess ris$ ofendometrialhyperplasia• (odyweight ) *+

    $g• Age ) ,- years• ther ris$ factors

    Assess endometrium• %ransvaginal

    ultrasound /%012 or• Endometrial biopsyif endometrium )"# mm or if %01 notavailable

    'yperplasticendometrium orcarcinoma

    (iopsy

    3nexplainedheavy

    menstrualbleeding

    4ormalendometri

    um

    • 5evonorgestrelintrauterine system

    • %ranexamic acid• 4onsteroidal anti

    in6ammatoryagents

    • 4orethisterone/long course2

    • c pill• 7ana olIf one medical therap failsothers can !e "sed

    8er medicaltherapy

    %reatmentsuccess

    Evaluationand

    consideration for

    surgery

    9ontinuemedicaltherapy

    'igh ris$:

    4o

    ;es

    : Referral to specialist could be


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