History of heavy menstrual bleeding

• aspects to be covered in the history include:
  • nature of the bleeding
  • related symptoms that might suggest structural or histological abnormality e.g. intermenstrual or post-coital 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 post-coital 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:

1. Heavy menstrual bleeding: assessment and management. NG88. NICE Guideline (March 2018 - updated May 2021)