The diagnosis of heavy menstrual bleeding is a subjective one. It is where there has been heavy menstrual loss over several months, which has interfered with emotional, physical and social wellbeing.
heavy menstrual bleeding or is a consequence of it.
One of the first things that doctors look for is pallor, which may be a sign of anaemia.
The next thing would be to perform a pelvic examination looking at the cervix and then try to establish the size of the womb. It may be enlarged particularly in women with fibroids or Adenomyosis.
After the examination the doctor will then go on to order a number of investigations depending on the symptoms presented and the results of the physical examination. Some investigations are also age dependent
The first investigation is usually a full blood count to see whether the periods have been severe enough to cause anaemia.
The next investigation is an ultrasound scan which is helpful in the identification of fibroids and sometimes polyps.
The ultrasound is usually performed transvaginally (Transvaginal ultrasound scan) as this gives the best results.
If the ultrasound scan returns as normal and fertility is not an issue most women are managed with medication in primary care. If on the other hand investigations point towards a treatable abnormality most women are referred to see a gynaecologist or if initial treatment in the community has failed.
Once referred to secondary care appropriate investigations would depend on age of presentation and the desire for future or immediate fertility
For women over the age of 45 years an endometrial biopsy is taken. This is done where a thin tube is passed through the neck of the womb and a sample taken from the lining of the womb for laboratory analysis
For the majority of women the results will return with no concerns, however the risk of cancer of the womb increases with age and if caught early is completely curable. The overall risk is about less than 1% below the age of 45years.
In other women the diagnosis may be that of “overgrowth” of the lining of womb known as endometrial hyperplasia. This in itself is not cancerous but carried the risk of developing cancer in the future. There are different variants and how it is managed depends on age as well as whether family is complete or not.
For some women to establish or rule out the diagnosis of fibroids or polyps a hysteroscopy may be necessary. This is where a very fine telescope is inserted through the neck of the womb to visualize the inside of the womb. Most of the time this can be done in the outpatients without the need for a general anaesthetic.
Nowadays there are one-stop clinics where all these investigations can be done in one setting, a diagnosis established and treatment started. In well established centres small polyps or fibroids can be removed there and then.