42. Menstrual Problems: Heavy Menstrual Bleeding and Primary Dysmenorrhoea

  1. D. Keith Edmonds FRCOG, RRACOG
  1. Andrew W. Horne PhD, MRCOG and
  2. Hilary O. D. Critchley BSc, MD, FRCOG, FMedSci

Published Online: 5 JAN 2012

DOI: 10.1002/9781119979449.ch42

Dewhurst's Textbook of Obstetrics & Gynaecology, Eighth Edition

Dewhurst's Textbook of Obstetrics & Gynaecology, Eighth Edition

How to Cite

Horne, A. W. and Critchley, H. O. D. (2012) Menstrual Problems: Heavy Menstrual Bleeding and Primary Dysmenorrhoea, in Dewhurst's Textbook of Obstetrics & Gynaecology, Eighth Edition (ed D. K. Edmonds), Wiley-Blackwell, Oxford, UK. doi: 10.1002/9781119979449.ch42

Editor Information

  1. Queen Charlotte's & Chelsea Hospital, London, UK

Author Information

  1. MRC Centre for Reproductive Health, University of Edinburgh, The Queen's Medical Research Institute, Edinburgh, UK

Publication History

  1. Published Online: 5 JAN 2012
  2. Published Print: 10 JAN 2012

ISBN Information

Print ISBN: 9780470654576

Online ISBN: 9781119979449

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Keywords:

  • fibroid;
  • coagulopathy;
  • antifibrinolytic;
  • prostaglandin synthetase inhibitor;
  • progestogen;
  • combined oral contraceptive pill;
  • levonorgestrel releasing intrauterine system;
  • endometrial ablation;
  • uterine artery embolization;
  • hysterectomy

Summary

Heavy menstrual bleeding (HMB) is a common gynaecological complaint with significant morbidity. Causes of HMB include fibroids, polyps, coagulopathies and, more rarely, malignancy, thyroid disease, infection and arteriovenous malformations. In the majority of cases, the cause of bleeding is unknown. All women with HMB should be screened for anaemia. Histological assessment of the endometrium is only required in symptomatic women over 45 years or in younger women when treatment has failed. Management of HMB is dependent on cause but most cases respond to medical or surgical approaches. Medical treatments for HMB include antifibrinolytics, prostaglandin synthetase inhibitors, oral progestogens, the combined oral contraceptive pill, injected/depot progestogens, gonadotrophin releasing hormone analogues and the levonorgestrel releasing intrauterine system. Surgical treatments include polypectomy, endometrial ablation, myomectomy, uterine artery embolization, and hysterectomy.