Clinical Case Database / Category: Patient Management

Management Of Abnormal Menstrual Bleeding

Publication details

Dr Alexander Field BSc MBB, PGCertMedED, MRCOG, Dr Sarah Jean Prince BSc, MBBS, Mr Chris Spencer MD, FRCOG
Foundation Years Journal, volume 8, issue 9, p.46 (123Doc Education, London, October 2014)


Heavy menstrual bleeding (HMB) commonly presents in general practice and, although not usually associated with significant morbidity, it is associated with a significant impact on quality of life issues as well as financial costs to the National Health Service. Over the last 20 years, there have been significant improvements in the way that HMB has been managed: up until the early 1990s at least 60% of women with HMB would undergo hysterectomy - often as a first line treatment (1). With the advent of the Mirena Intrauterine System (IUS), most HMB cases can now be managed effectively in primary care. The development of conservative surgical techniques such as endometrial ablation mean that even those who fail to respond to medical treatment can still avoid undergoing hysterectomy with all of its potential complications.

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Dr Alexander Field BSc MBB, PGCertMedED, MRCOG

ST4 Obstetrics and Gynaecology
Basildon and Thurrock Univeristy Hopsitals NHS Foundation Trust Nethermayne, Basildon, Essex, SS16 5NL

Dr Sarah Jean Prince BSc, MBBS

ST3 Obstetrics and Gynaecology
Mid Essex Hospital Services NHS Trust Broomfield Hospital, Court Road, Broomfield Chelmsford, Essex, CM1 7ET

Mr Chris Spencer MD, FRCOG

Consultant Obstetrician & Gynaecologist Mid Essex Hospital Services NHS Trust Broomfield Hospital, Court Road, Broomfield Chelmsford, Essex, CM1 7ET


1. National Collaborating Centre for Women's and Children's Health.Heavy Menstrual Bleeding: Nice Clinical Guideline 44. s.l. : National Institute for Health and Care Excellence, January 2007.
2. Royal College of Obstetricians and Gynaecologists. History and clinical coagulation screen. StratOG. [Online] Royal College of Obstetricians and Gynaecologists, 2010. page/history-and-clinical-coagulation-screen.
3. Levonorgestrel Intrauterine System versus Medical Therapy for Menorrhagia. Gupta, Janesh, et al. January 2013, New England Journal of Medicine, Vol. 368, pp. 128-137.
4. Levonorgestrel-Releasing Intrauterine System vs. Usual Medical Treatment for Menorrhagia: An Economic Evaluation Alongside a Randomised Controlled Trial. Sanghera, Sabina, et al. 3, March 2014, PLOS One, Vol. 9.
5. Effective treatment of heavy and/or prolonged menstrual bleeding without organic cause: pooled analysis of two multinational, randomised, double-blind, placebo-controlled trials of oestradiol valerate and dienogest. Fraser, Ian, et al. 4, August 2011, The European Journal of Contraception and Reproductive Health Care, Vol. 16, pp. 258-269.
6. Ten-year literature review of global endometrial ablation with the NovaSure device. Gimpelson, Richard. 2014, International Journal of Women's Health, Vol. 6, pp. 269-280.
7. Royal College of Obstetricians and Gynaecologists, Royal College of Radiologists.Clinical recommendations on the use of uterine artery embolisation (UAE) in the management of fibroids. s.l. : Royal College of Obstetricians and Gynaecologists, Royal College of Radiologists, 2013.


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T​he Foundation Years Clinical Cases Database is​ a selection of 600 peer-reviewed clinical cases in the field of patient safety and clinical practice, specifically focused on the clinical information needs of junior doctors, based around the Foundation Year Curriculum programme (MMC). The cases have been chosen to align with the Foundation Year Curriculum.

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