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Treating heavy menstrual bleeding

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Heavy menstrual bleeding (HMB) affects women from menarche to perimenopause. An understanding of the basics of diagnosis, examination, investigation and management are essential for all healthcare professionals. Nurses and advanced nurse practitioners (ANPs) often feel that the gynaecological component was limited during their training. This article updates nurses on treatment options for HMB.

HMB is defined as 'excessive menstrual blood loss which interferes with a woman's physical, social, emotional and/or material quality of life.'1 'It can occur alone or in combination with other symptoms'.2

HMB is the fourth most common reason for referral to secondary care and it has a significant effect on women's quality of life (QOL). In England alone each year, 88,000 women are referred to secondary care with HMB and 28,000 of them will undergo surgery. HMB represents 15 per cent of all gynaecological referrals.3

The priorities for all ANPs are to take a detailed history,2,4 carry out a pelvic examination, investigate appropriately (swabs, smear, bloods and ultrasound if indicated) and to offer the patient evidence-based management. It is a priority to rule out any pathology that will need referral before any treatment is started.

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