Page 10 - EVALUATION OF TREATMENT FOR HEAVY MENSTRUAL BLEEDING by Herman, Malou

Chapter 1
Heavy menstrual bleeding (HMB) is a common reason for general practice consultations in the primary care setting and specialist referral. About 30-50% of all menstruating women report that their periods are (very) heavy, and of these women 25% report that their periods are a marked or severe problem. HMB has a significant impact on the medical, socio-economic and psychological well- being of women. Therefore, there is a need for effective (diagnostic) strategies and treatment modalities.
HMB is defined as menstruation at regular intervals but with excessive flow and duration. The aetiology is diverse. HMB can be caused by abnormal blood clotting, disruption of hormonal regulation or uterine pathology (e.g., fibroids, polyps, adenomyosis). The cause of the HMB should, of course, be investigated first. Clinically, HMB is defined as blood loss of more than 80mL per cycle, a definition given by Hallberg et al. However, the 80-mL criterion of blood loss is of limited clinical usefulness. The diagnosis and treatment of patients appears to be unrelated to the volume of blood loss. Women’s perception of the severity of bleeding does not always correlate with the objective amount of blood loss. Warner et al. found that merely 34% women exceed the 80mL threshold.11 Thus, not only the amount of bleeding, but probably also the way these women cope with the problem plays an important role in their complaints. Therefore, one should ascertain whether there are additional (psychological) factors that could cause women to present with complaints of HMB. For example, women in vulnerable psychological states are more likely to have coping difficulties regarding their gynaecological status than women who are more psychologically healthy.12,13 Thus, the 80-mL criterion should be challenged as well as the idea that volume captures the complaints of those suffering from heavy periods. Perhaps a more patient-centred definition should be used and the HMB criteria redefined. Nevertheless, defining the blood loss problem women experience should be the first step in diagnosing. Any complaints about blood loss should therefore be fully examined. Only after the underlying cause has been identified can the best treatment option be chosen.
Diagnosis of HMB
Objectively knowing whether or not the blood loss is excessive could be very beneficial for both patient and clinician. This determination will not only clarify the complaint, but it will also influence the choice and expectations of treatment. A few methods have been developed for measuring menstrual blood loss (MBL).
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