Heavy menstrual bleeding (HMB)

Heavy menstrual bleeding (HMB) for undergraduate students

1. Heavy Menstrual Bleeding Dr. Shazia Iqbal  Assistant Professor (Obstetrics & Gynaecology ) Alfarabi College of Medicine, Riyadh [email protected] https ://www.researchgate.net/profile/Shazia_Iqbal7 https://orcid.org/0000-0003-4890-5864

2. OVERVIEW The menstrual cycle is more than just the period . In fact, the period is just the first phase of the cycle. The menstrual cycle is actually made up of two cycles that interact and overlap—one happening in the ovaries and one in the uterus. The brain, ovaries, and uterus work together and communicate through hormones (chemical signals sent through the blood from one part of the body to another) to keep the cycle going.

3. Etc… The length of the menstrual cycle varies from woman to woman, but the average is to have periods every 28 days. Regular cycles that are longer or shorter than this, from 21 to 40 days, are normal. The menstrual cycle is regulated by the complex interaction of hormones: luteinizing hormone , follicle-stimulating hormone , and the female sex hormones estrogen and progesterone. The menstrual cycle has three phases: Follicular (before release of the egg)

4. Signs and symptoms of period It start at 11y/old to 51y/old Most women experience minor symptoms just before and during their periods. Tender breasts . Bloating , fluid retention. Muscle aches. Joint pain. Headaches. Acne. Abdominal cramps . Diarrhea or constipation

5. Heavy menstrual bleeding Menorrhagia is the medical term for menstrual periods with abnormally heavy or prolonged bleeding. Although heavy menstrual bleeding is a common concern, most women don't experience blood loss severe enough to be defined as menorrhagia.

6. Etc… With menorrhagia, the woman can't maintain her usual activities when she have her period because she have so much blood loss and cramping. If she dread her period because she have such heavy menstrual bleeding, talk with her doctor. There are many effective treatments for menorrhagia.

7. Heavy Menstrual Bleeding ( video )

8. Signs and symptoms Soaking through one or more sanitary pads or tampons every hour for several consecutive hours Needing to use double sanitary protection to control your menstrual flow Needing to wake up to change sanitary protection during the night Bleeding for longer than a week Passing blood clots larger than a quarter Restricting daily activities due to heavy menstrual flow Symptoms of anemia, such as tiredness, fatigue or shortness of breath

9. causes Hormone imbalance. In a normal menstrual cycle, a balance between the hormones estrogen and progesterone regulates the buildup of the lining of the uterus (endometrium), which is shed during menstruation. If a hormone imbalance occurs, the endometrium develops in excess and eventually sheds by way of heavy menstrual bleeding.

10. Etc.. Uterine fibroids Polyps These noncancerous (benign) tumors of the uterus appear during your childbearing years. Uterine fibroids may cause heavier than normal or prolonged menstrual bleeding. Cancer Uterine cancer and cervical cancer can cause excessive menstrual bleeding, especially if you are postmenopausal or have had an abnormal Pap test in the past.

11. Etc… Pregnancy complications A single, heavy, late period may be due to a miscarriage. Another cause of heavy bleeding during pregnancy includes an unusual location of the placenta, such as a low-lying placenta or placenta previa .

12. Other causes Dysfunction of the ovaries Adenomyosis . intrauterine device (IUD) Medications

13. Risk factors Adolescent girls who have recently started menstruating . Girls are especially prone to anovulatory cycles in the first year after their first menstrual period (menarche). Older women approaching menopause . Women ages 40 to 50 are at increased risk of hormonal changes that lead to anovulatory cycles.

14. History • What age did menses start? the cycles are irregular or regular? • How many days does each cycle last? • In terms of the menorrhagia ask: • How many times they change their tampon or pad in a day? • Are there incidents of flooding? Excessive clot production?

15. Etc… Dysmenorrhoea ? Intermenstrual bleeding? Post-coital bleeding? Symptoms of anaemia ? Contraception? PID?

16. Etc… • Vaginal discharge ? • Recent coil insertion ? • Pressure symptoms on bladder and bowel? • Coagulation disorders?

17. History ( video )

18. Test and diagnosis Blood tests . evaluate for iron deficiency (anemia) and other conditions, such as thyroid disorders or blood-clotting abnormalities. Pap test . cells from cervix are collected and tested for infection, inflammation or cancerous changes. Endometrial biopsy . is the removal of a small piece of tissue from the endometrium (the lining of the uterus).

19. Pap test

20. Endometrial biopsy

21. Etc… Ultrasound scan . To rule out any abnormality in uterus. Sonohysterogram . During this test, a fluid is injected through a tube into uterus by way of vagina and cervix using ultrasound to look for problems in the lining of uterus. Hysteroscopy . This exam involves inserting a tiny camera through vagina and cervix into uterus, which allows to see the inside of uterus.

22. sonohysterogram

23. Hysteroscopy

24. Treatment ( medication ) Nonsteroidal anti-inflammatory drugs (NSAIDs) Tranexamic acid Oral contraceptives Oral progesterone Hormonal IUD ( Liletta , Mirena )

25. treatment ( surgery ) Dilation and curettage (D&C) Uterine artery embolization Focused ultrasound surgery Myomectomy Endometrial ablation Endometrial resection Hysterectomy

26. Summary ( video )

27. References Oxford handbook https://www.cdc.gov/ncbddd/blooddisorders/women/menorrhagia.html https://my.clevelandclinic.org/health/diseases/17734-menorrhagia-heavy-menstrual-bleeding https://www.mayoclinic.org/diseases-conditions/menorrhagia/symptoms-causes/syc-20352829 https://www.youtube.com/watch?v=pt10QlCTBh8&feature=youtu.be https://www.youtube.com/watch?v=p0qQiYXg7sA https://www.youtube.com/watch?v=ayV_avYyKns

28. Thank you for listening Any questions ?