Heavy Menstrual Bleeding (HMB)
Heavy menstrual bleeding is a common condition affecting one in five women in Australia and New Zealand.
Heavy menstrual bleeding or heavy periods
Defined by a menstrual blood loss of more than 80 mm during a period. Being difficult to measure this way, diagnosis is made on the basis of other signs like – longer lasting periods, frequent flooding, increasing a changing frequency or iron deficiency in the blood.
The few main causes of bleeding (Heavy Menstrual Bleeding- HMB) are:
- Fibroids- Non-cancerous growth of muscle and connective tissues in uterine wall. Often found in women with HMB, but most women with fibroids do not have HMB.
- Endometrial polyps or hyperplasia- Benign growth on uterine lining or thickening of lining
- Dysfunctional Uterine Bleeding- where no uterine abnormality is found. More than 50% of HMB falls under this category.
- Enlargement of uterus
- Thyroid imbalance
Primary diagnosis is performed by internal examination, blood test for haemoglobin levels, or ultrasound scan. If required, further diagnosis is done by Hysteroscopy – generally an inpatient procedure to look inside the uterus using the thin telescope. Alternatively, diagnostic laparoscopy can be performed.
Nonsurgical management involves administering medicines like non-steroidal anti-inflammatory drugs, oral contraceptive pills, oral progesterone or tranexamic acid, to name a few. Sometimes a progesterone intrauterine device is also inserted as part of treatment.
As Heavy Menstrual Bleeding (HMB) generally, causes anaemia, iron supplementation is recommended.
Endometrial ablation – removal or destruction of lining of uterus using a hysteroscope, a new technique using low intensity microwaves to remove endometrium is being evaluated.
Myomectomy – surgical removal of fibroids within the uterus
Hysterectomy – removal of the uterus either by abdominal hysterectomy, vaginal hysterectomy or laparoscopic hysterectomy.
All surgical procedures come with their own set of risks and therefore it is important to consider all the risks before deciding on a particular treatment.