Heavy menstrual bleeding: work-up and management.


Journal Article (Review)

Heavy menstrual bleeding (HMB), which is the preferred term for menorrhagia, affects ∼90% of women with an underlying bleeding disorder and ∼70% of women on anticoagulation. HMB can be predicted on the basis of clots of ≥1 inch diameter, low ferritin, and "flooding" (a change of pad or tampon more frequently than hourly). The goal of the work-up is to determine whether there is a uterine/endometrial cause, a disorder of ovulation, or a disorder of coagulation. HMB manifest by flooding and/or prolonged menses, or HMB accompanied by a personal or family history of bleeding is very suggestive of a bleeding disorder and should prompt a referral to a hematologist. The evaluation will include the patient's history, pelvic examination, and/or pelvic imaging, and a laboratory assessment for anemia, ovulatory dysfunction, underlying bleeding disorder, and in the case of the patient on anticoagulation, assessment for over anticoagulation. The goal of treatment is to reduce HMB. Not only will the treatment strategy depend on whether there is ovulatory dysfunction, uterine pathology, or an abnormality of coagulation, the treatment strategy will also depend on the age of the patient and her desire for immediate or long-term fertility. Hemostatic therapy for HMB may serve as an alternative to hormonal or surgical therapy, and may even be life-saving when used to correct an abnormality of coagulation.

Full Text

Duke Authors

Cited Authors

  • James, AH

Published Date

  • December 2, 2016

Published In

Volume / Issue

  • 2016 / 1

Start / End Page

  • 236 - 242

PubMed ID

  • 27913486

Pubmed Central ID

  • 27913486

Electronic International Standard Serial Number (EISSN)

  • 1520-4383

Digital Object Identifier (DOI)

  • 10.1182/asheducation-2016.1.236


  • eng

Conference Location

  • United States