GEM - heavy menstrual bleeding with reference to NICE guidance

GPnotebook Educational Module (GEM) - heavy menstrual bleeding

Menorrhagia (heavy menstrual bleeding) is defined as excessive menses in an otherwise normal menstrual cycle. It is largely a subjective definition as what constitutes heavy bleeding to one women may be quite normal for another.

How do NICE define the term heavy menstrual bleeding?

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How common is heavy menstrual bleeding?

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What causes should be considered if a woman presents with a history of heavy menstrual bleeding?

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What are important features of the history when a woman presents with a history of heavy menstrual bleeding?

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What laboratory investigations are indicated in cases of heavy menstrual bleeding?

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Management in primary care:

With respect to management of heavy menstrual bleeding?

• when is pharmaceutical management indicated?
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• if history and investigations indicate that pharmaceutical treatment is appropriate and either hormonal or non-hormonal treatments are acceptable, then what order have NICE suggested that treatments should be considered?
• if menorrhagia/heavy menstrual bleeding (HMB) is managed with non-hormonal treatments, when would treatment with a NSAID be advantageous?
• is imaging indicated after a failure of a first pharmaceutical agent?
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• what is a pharmaceutical regime to stop flooding/torrential menstrual bleeding?
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Referral from primary care:

• When should an urgent two week referral for suspected gynaecological cancer be initiated?
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Reference:

1. Royal College of General Practitioners. Curriculum Statement 10.1 Women's Health.