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Menorrhagia (Heavy Menstrual Bleeding)

Miguel A. Palacios, MD and Maizal Cuauhtemoc Rivera, FNP Reviewed 06/2019
 


BASICS

DESCRIPTION

  • The current preferred terminology for menorrhagia is “heavy menstrual bleeding” (HMB).

  • HMB is an excessive amount (≥80 mL/cycle, compared with normal average of 30 to 60 mL/cycle) or ...

DIAGNOSIS

HISTORY

  • Suggestive historical features for HMB:

    • Bleeding substantially heavier than patient’s usual flow

    • Changing sanitary products every 1 to 2 hours or the need to change protection overnight

    • ...

TREATMENT

GENERAL MEASURES

Treat underlying conditions (e.g., hypothyroidism) when possible. 

MEDICATION

First Line

  • For acute control of severe bleeding (5):

    • Obtain IV access and consider blood transfusion...

ONGOING CARE

DIET

Iron supplementation may help correct for increased blood loss. 

PATIENT EDUCATION

Patient and provider should engage in informed decision making with understanding of treatment risks a...

REFERENCES

1
Marjoribanks J, Lethaby A, Farquhar C. Surgery versus medical therapy for heavy menstrual bleeding. Cochrane Database Syst Rev.  2016;(1): CD003855. [View Abstract on OvidMedline]
2
Com...

CODES

ICD10

  • N92.0 Excessive and frequent menstruation with regular cycle

  • N92.3 Ovulation bleeding

  • N92.2 Excessive menstruation at puberty

  • N92.1 Excessive and frequent menstruation with irregular cycle

ICD9

  • ...

CLINICAL PEARLS

  • Women with HMB are at high risk for iron deficiency anemia.

  • A thorough menstrual history is critical to differentiate HMB from similar conditions including anovulatory bleeding.

  • Teenager...

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