Heavy menstrual bleeding – how to treat and what to look out for

Heavy menstrual bleeding (HMB) is one of the most common reasons for gynaecological consultations in General practice. Many women presenting with HMB will only ever require simple treatment without the need for further investigations.  However, some women with HMB may have an underlying pathology.

The main aim is to help the general practitioners to advise each woman with HMB about the treatments that are right for her, with a clear focus on the woman’s choice; to investigate the cause of heavy periods that are affecting a woman’s quality of life and to offer the right treatments, considering the woman’s priorities and preferences.  

Most patients will only ever require simple treatment without the need for further investigations. However, some women with HMB may have an underlying pathology, which is often not apparent from the woman’s history or examination and further investigations to identify the cause may be needed.  

The aim of investigation is to identify structural abnormalities such as submucosal fibroids, larger fibroids, polyps or adenomyosis, and to also detect rare and potentially serious pathologies such as endometrial hyperplasia or carcinoma. 

The effect of fibroids on fertility is poorly understood, that effect is likely to be related to the fibroid size, position subserosal (SS), intramural (IM) or submucosal (SM) and number. The outcome of previous fertility treatments and pregnancies will also guide management  

Whilst the cause of HMB will not always be apparent from the investigation, women may also gain reassurance in knowing that no serious pathology is causing their symptoms, and that no treatable lesion was missed that would make simple treatments less effective. 

Learning outcomes:

By the end of this session you will be able to:

• Recognize why physical examination should be undertaken before all investigations. 
• Explain and order appropriate investigations 
• To provide practice guidance on the assessment and management of uterine fibroids. 
• Demonstrate an increased knowledge of the risk factors for endometrial pathology. 
• Provide information and discuss possible treatment options with women. 

SPEAKER

Dr Midia Alias, Obstetrician and Gynaecologist, Joan Kirner Women's & Children's Hospital

Dr Midia Alias is senior Obstetrician and Gynaecologist who deals with all women’s health conditions with emphasis on overall wellbeing; and holistic approach to prepare for pregnancy in collaboration with the primary health care workers. 

Dr. Midia Alias has obtained her fellowship from Royal Australian College of Obstetrician and Gynaecologist, trained in various institutions in Victoria and New South Wales, promoting collaborative medical and midwifery care. She is committed to delivering the highest level of care and professionalism for her patients with diligence, integrity, respect and compassion. 

Currently working as a VMO in both public and private Hospitals in Melbourne (Sunshine Hospital /Joan Kirner, Northpark Private in Bundoora, Western private /Footscray and St Vincent private Hospital) 

Other positions: 

• FRANZCOG Training Supervisors. 
• AMC examiner for Australian Medical Council.