Treatment Guideline Chart
Heavy menstrual bleeding is prolonged (>7 days) or excessive (>10 mL) uterine bleeding occurring at regular intervals over several menstrual cycles.
It is menstrual blood loss that is excessive and interferes with patient's physical, emotional, social and quality of life.
It is also referred to as menorrhagia or hypermenorrhea.
It is a common problem in women of reproductive age that usually causes anemia.
Uterine fibroids and polyps are the most common pathology identified.

Heavy Menstrual Bleeding References

  1. Apgar B, Kaufman A, George-Nwogu U, et al. Treatment of menorrhagia. Am Fam Physician. 2007 Jun;75(12):1813-1819. PMID: 17619523
  2. Casablanca Y. Management of dysfunctional uterine bleeding. Obstet Gynecol Clin North Am. 2008 Jun;35(2):219-234. doi: 10.1016/j.ogc.2008.03.001. PMID: 18486838
  3. James AH. Bleeding disorders in adolescents. Obstet Gynecol Clin North Am. 2009 Mar;36(1):153-162. doi: 10.1016/j.ogc.2008.12.002. PMID: 19344853
  4. Choudry A, Malik A, Choudry H, et al. Effectiveness and safety of Levonorgestrel releasing intrauterine system in treatment of menorrhagia secondary to oral anticoagulations and chronic liver disease. Rawal Medical Journal. 2009;34(2):187-190. http://www.rmj.org.pk. Accessed 21 Mar 2011
  5. Duckitt K. Managing perimenopausal menorrhagia. Apr 15, 2010. Maturitas. 2010 Jul;66(3):251-256. http://win.menopausaitaliana.it/articoli2010/menorragia-perimenopausale.pdf. Accessed 21 Mar 2013. PMID: 20399041
  6. James AH, Kouides PA, Abdul-Kadir R, et al. Von Willebrand disease and other bleeding disorders in women: consensus on diagnosis and management from an international expert panel. May 30, 2009. Am J Obstet Gynecol. 2009 Jul;201(1):e1-e8. http://download.journals.elsevierhealth.com. Accessed 21 Mar 2013. PMID: 19481722
  7. ACOG practice bulletin no. 110: noncontraceptive uses of hormonal contraceptives. Obstet Gynecol. 2010 Jan;115(1):206-218. doi: 10.1097/AOG.0b013e3181cb50b5. Accessed 21 Mar 2011. PMID: 20027071
  8. Lai SW, Mok SL, Lam SK. An update on the management of heavy menstrual bleeding. Hong Kong Gynaecol Obstet Midwifery. 2009;9:50-56. http://www.ogshk.org.
  9. Lobo RA. Abnormal uterine bleeding: ovulatory and anovulatory dysfucntional uterine bleding, management of acute and chronic excessive bleeding. In: Katz VL, Lentz GM, Lobo RA, Gerhenson DM. Comprehensive Gynecology. 6th ed. Philadelphia: Mosby, Elsevier; 2012
  10. MedWormhttp://www.medworm.com/rss/index.php/OBGYN/29/http://www.medworm.com/rss/medicalfeeds/specialities/OBGYN.xml
  11. National Collaborating Centre for Women's and Children's Health. Heavy menstrual bleeding. London: Royal College of Obstetricians and Gynaecologists. NICE. http://www.nice.org.uk. Jan 2007.
  12. American College of Radiology. ACR appropriateness criteria. Abnormal vaginal bleeding. http://www.acr.org. 2007. Accessed 21 Mar 2011.
  13. Hestiantoro A, et al. Terminologi Pendarahan Uterus Abnormal. In: Himpunan Endokrinologi Reproduksi dan Fertilitas Indonesia (HIFERI), Perkumpulan Obstetri dan Ginekologi Indonesia (POGI). Konsensus Tatalaksana Pendarahan Uterus Abnormal Karena Efek Samping Kontrasepsi. Jakarta; 2013:8-43.
  14. Ministry of Health Malaysia. Management of menorrhagia. http://www.acadmed.org.my. Dec 2004.
  15. Munro MG, Critchley HO, Broder MS, Fraser IS; FIGO Working Group on Menstrual Disorders. FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age. Int J Gynaecol Obstet. 2011 Apr;113(1):3-13. doi: 10.1016/j.ijgo.2010.11.011. Accessed 27 Jun 2014. PMID: 21345435
  16. Munro MG, Critchley HO, Fraser IS. The FIGO systems for nomenclature and classification of causes of abnormal uterine bleeding in the reproductive years: who needs them. Am J Obstet Gynecol. 2012 Oct;207(4):259-265. doi: 10.1016/j.ajog.2012.01.046. Accessed 27 Jun 2014. PMID: 22386064
  17. Singh S, Best C, Dunn S, Leyland N, Wolfman WL; Clinical Practice – Gynaecology Committee; Society of Obstetricians and Gynaecologists of Canada. Abnormal uterine bleeding in pre-menopausal women. J Obstet Gynaecol Can. 2013 May;35(5):473-479. http://sogc.org. Accessed 30 Jun 2014. PMID: 23756279
  18. Zacur HA. Chronic menorrhagia or anovulatory uterine bleeding. UpToDate. http://www.uptodate.com. 27 Sep 2010.
  19. Arendas K, Leyland NA. Use of ulipristal acetate for the management of fibroid-related acute abnormal uterine bleeding . J Obstet Gynaecol Can. 2016 Jan;38(1):80-83. doi: 10.1016/j.jogc.2015.11.005. Accessed 19 Oct 2016. PMID: 26872761
  20. National Institute for Health and Care Excellence. Heavy menstrual bleeding: assessment and management. NICE. https://www.nice.org.uk. Aug 2016. Accessed 18 Oct 2016.
  21. Bano R, Datta S, Mahmood TA. Heavy menstrual bleeding. Obstetrics, Gynaecology and Reproductive Medicine. 2016 Jun;26(6):167-174. http://dx.doi.org/10.1016/j.ogrm.2016.03.005.
  22. Heikinheimo O, Fraser I. The current status of hormonal therapies for heavy menstrual bleeding. Best Pract Res Clin Obstet Gynaecol. 2017 Apr;40:111-120. doi: 10.1016/j.bpobgyn.2017.01.001. PMID: 28238590
  23. Kaunitz AM. Management of abnormal uterine bleeding. UpToDate. https://www.uptodate.com. 12 Apr 2017.
  24. Milbourne A. Heavy or irregular uterine bleeding during chemotherapy. UpToDate. https://www.uptodate.com. 30 Mar 2016.
  25. American College of Obstetricians and Gynecologists. Screening and management of bleeding disorders in adolescents with heavy menstrual bleeding: ACOG COMMITTEE OPINION, Number 785. Obstet Gynecol. 2019 Sep;134(3):e71-e83. doi: 10.1097/AOG.0000000000003411. PMID: 31441825
  26. National Institute for Health and Care Excellence. Heavy menstrual bleeding: assessment and management. NICE. http://www.nice.org.uk. 31 Mar 2020.
  27. Singh S, Best C, Dunn S, et al. No. 292-abnormal uterine bleeding in pre-menopausal women. J Obstet Gynaecol Can. 2018 May;40(5):e391-e415. doi: 10.1016/j.jogc.2018.03.007. PMID: 29731212
  28. Wouk N, Helton M. Abnormal uterine bleeding in premenopausal women. Am Fam Physician. 2019 Apr;99(7):435-443. https://www.aafp.org.
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