Heavy menstrual bleeding (HMB) for undergraduate students

2.  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.  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.  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.  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.  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.

8.  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.  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.  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.  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.  Dysfunction of the ovaries
 Adenomyosis.
 intrauterine device (IUD)
 Medications

13.  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.  • 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.  Dysmenorrhoea?
 Intermenstrual bleeding?
 Post-coital bleeding?
 Symptoms of anaemia?
 Contraception?
 PID?

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

18.  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).

21.  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.

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

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

27.  Oxford handbook
 https://www.cdc.gov/ncbddd/blooddisorders/women/menor
rhagia.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.  Any questions ?