QuizMe 4

Heavy Menstrual Bleeding (HMB)

A 40 year old  lady presented with heavy menstrual bleeding for the last 5 months. Her periods are regular. History of intermittent bloating and primary subfertility were noted . Upon examination , her uterus was enlarged. Vagina and cervix were normal.

  • Bulky uterus
  • Normal cervix
  • Primary Subfertility
  • Fibroid uterus
  • Endometrosis/Adenomyosis
  • Ultrasound scan; depending on the outcome further investigations can be arranged.
  • Consider hysteroscopy  and endometrial biopsy

Multi-fibroid uterus, submucous fibroids 2.5 cm  impinging  on the endometrium 

  • Medical trial of Mirena IUS or other progesterone treatments
  • Surgical – Hysteroscopic resection of the submucous fibroid 

Uterine fibroids (leiomyomas or myomas) are benign tumours of smooth muscle cells and fibrous tissue that develop within the wall of the uterus. They are the most common tumours of the female genital tract present in 20–40 % of women in the reproductive age group. Treatment is often only required if the woman is symptomatic and is dependent on symptoms. If the woman has heavy menstrual bleeding, the National Institute for Health and Care Excellence (NICE) 294 recommends consideration of pharmaceutical treatment when fibroids are less than 3 cm in diameter and causing no distortion of the uterine cavity