history of heavy menstrual bleeding
Last edited 06/2018
- aspects to be covered in the history include:
- nature of the bleeding
- related symptoms that might suggest structural or histological abnormality e.g.such as intermenstrual or postcoital bleeding, pelvic pain and/or pressure symptoms
- impact on quality of life and other factors that may determine treatment
options (such as presence of comorbidity)
- when diagnosing heavy menstrual bleeding (HMB), clinicians should take into
account the range and natural variability in menstrual cycles and blood loss
- the clinician should also discuss this variation with the woman
- if the woman has a history of HMB without other related symptoms (such as
persistent intermenstrual bleeding, pelvic pain and/or pressure symptoms,
that might suggest uterine cavity abnormality, histological abnormality, adenomyosis
or fibroid), consider pharmacological treatment without carrying out a physical
examination (unless the treatment chosen is levonorgestrel-releasing intrauterine
system [LNG IUS])
- if the history suggests HMB with structural or histological abnormality,
with symptoms such as intermenstrual or postcoital bleeding, pelvic pain and/or
pressure symptoms, a physical examination and/or other investigations (such
as ultrasound) should be performed
- measuring menstrual blood loss is not routinely recommended for HMB
- NICE emphasise that whether menstrual blood loss is a problem should be determined not by measuring blood loss but by the woman herself
Reference: