heavy%20menstrual%20bleeding
HEAVY MENSTRUAL BLEEDING
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%20menstrual%20bleeding Signs and Symptoms

Introduction

  • Common problem in women of reproductive age (increases with age) which usually causes anemia
    • Most common symptom experienced by women with bleeding disorder

Definition

  • Prolonged (>7 days) or excessive (>80 mL) uterine bleeding occurring at regular intervals over several menstrual cycles
    • Menstrual blood loss that is excessive and interferes with patient’s physical, emotional, social and quality of life

Etiology

  • Causes of abnormal uterine bleeding (AUB) are categorized into the following groups:
    • Discrete structural abnormalities that can be examined with imaging techniques and/or histopathology
      • PALM: Polyp, adenomyosis, leiomyoma, malignancy and hyperplasia
      • Please see Leiomyomas disease management chart for further information
    • Non-structural abnormalities that cannot be defined by imaging or histopathology
      • COEIN: Coagulopathy, ovulatory dysfunction, endometrial, iatrogenic, not otherwise classified
      • Coagulopathy includes von Willebrand’s disease (VWD) or platelet dysfunction
      • Iatrogenic causes include AUB associated with use of hormonal or non-hormonal medications (eg anticoagulation therapy), intrauterine systems or devices, or other local or systemic agents
      • Not otherwise classified causes include conditions that are rare or ill-defined that do not fit into any classification
    • Other causes include chronic endometrial infection, arteriovenous malformation, hypothyroidism, obesity
    • Patients may have >1 cause
  • Anovulation is the most common cause in adolescents and perimenopausal women; structural lesions and malignancy are more common with increasing age
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