PROLONGED AND HEAVY MENSTRUAL BLEEDING: MANAGEMENT

CONTENT

-INTRODUCTION

-FACTORS THAT MAY AFFECT THE CHOICE OF TREATMENT OF HMB

 

INTRODUCTION

Many women who complain of excesive menstrual bleeding are actually found to have a normal menstrual flow after a thorough assessment. By merely counselling such women that their blood loss is normal, it may be sufficient to reassure them and make the need for further investigations unnecessary. Becasue HMB has a diverse list of causes and yet in many instances no cause may be found, for women with confirmed cases of HMB, the aim of mangement is to treat and prevent anaemia, which is a complication of excessive bleeding and improve their quality of life by preventing any further excessive bleeding. Where specific causes are detected, specific treatments which may include medical, haematological and surgical treatments (e.g. polypectomy for endometrial polyps and myomectomy or hysterectomy for uterine fibroids) should be directed to the management of the HMB as will be discussed in specific sections on this site dedicated to the management of these diseases. For a significant others who have no known cause for their HMB i.e women with DUB, below is a general approach to their management.

Although, the treatment of DUB can be divided into medical and surgical mode of treatment, various factors must be put in place before deciding on the ideal method of treatment, as what may be ideal, may not be the desirable by a woman at presentation. An example include hysterectomy, which until lately has been the main stay of treatment of HMB for many years, is totally incompatible with fertility desires of many women. Yet for both HMB due to DUB and those due to many other pelvic diseases (e.g. uterine fibroids), it provides a permanent solution to the heavy mestrual bleeding, unlike medical and conservative surgical procedures (e.g. myomectomy) which although may provide a temporal relief, are often associated with a high chance of failure (medical) or recurrence ( conservative surgical method of treatment). Below are a list of factors that influence our management of HMB both for women with DUB and those with known gynaecological causes of HMB.

 

FACTORS THAT MAY AFFECT THE CHOICE OF TREATMENT OF HMB

1.  SEVERITY OF SYMPTOMS

Often times, the more severe the symptoms, the more the need for a more rapid and radical approach  to stem the cause of the bleeding and the more the tendency to resort to a surgical method of treatment early in the treatment of the woman.

2.  COMPLETION OF FAMILY SIZE

The completion of one’s family size makes it easier to choose any of the options of treatment that either confer a contraceptive benefit or render a woman infertile. E.g. Mirena, an IUD is appropriate for the management of DUB in many women who are not desirous of pregnancy and are not inclined towards surgery but is not ideal for women desirous of pregnancy while hysterectomy is ideal for women who have both completed their family size and desire a one off treatment, void of follow ups and reviews.

3.  THE DESIRE TO REMAIN FERTILE

The desire of a patient to have children obviously makes it nearly impossible to offer a patient an option that have contraceptive benefit or one that renders the patient infertile even if it is the best option for her, for example even after failure of medical therapy.

4.  CONTRACEPTIVE NEED

Many women who have HMB can combine the contraceptive benefit of some medical methods of treatment for child spacing along with the treatment of their symptoms, more especially when they are yet to complete their family size.

5.  PAST MEDICAL HISTORY

A woman’s comorbidity i.e. the presence of other long term diseases such as diabetis and hypertension are important in determining if a patient is fit for surgery or not. This may shape the management method based on safety of the procedure in the woman. Similarly, a woman’s past history of allergy, drug reactions, drug contraidications, past surgeries and current medications are all important in the choice of medications for medial treatment and the choice of anaesthesia for surgical treatment. 

6.  RELIGION AND BELIEF

The reigious belief and personal perception or view of a woman may shape how she accepts or refuses some treatment. For example, some women based on their faith may refuse contraception while others may refuse blood transfusion. Definitely any option containing contraception and increasing the risk of blood transfusion will be frowned upon by such women respectively.

 

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