Hello and welcome to the Zero to Finals podcast.

My name is Tom and in this episode I'm going to be talking to you about heavy menstrual bleeding.

You can find written notes on this topic at zero definals.com slash HMB

or in the gynecology section of the Zero to Finals, obstetrics and gynecology book. So let's get

straight into it. Heavy menstrual bleeding is also called menorrhager. On average, women lose 40

milliliters of blood during menstruation. Excessive menstrual blood loss involves more than 80 milliliters of blood.

The volume of blood loss is rarely measured in everyday clinical practice. The diagnosis is based

on symptoms such as changing pads every one to two hours, bleeding lasting more than seven days

and passing large clots.

A diagnosis can be made based on a self-report of very heavy periods.

Heavy menstrual periods can have a significant impact on the woman's quality of life.

So what are the causes of heavy menstrual bleeding? Disfunctional uterine bleeding

is where no identifiable cause is found and is a condition in and of itself. Heavy menstrual

bleeding can also be caused by extremes of reproductive age, fibroids, endometriosis and adenomyosis, pelvic inflammatory disease,

which is infection in the pelvis, contraceptives, particularly the copper coil, anticoagulant

medications such as aspirin, warfarin or doax, bleeding disorders such as von Willebran disease, endocrine

disorders such as diabetes and hypothyroidism, connective tissue disorders, endometrial

hypoplasia or endometrial cancer, and polycystic ovarian syndrome.

Next let's talk about taking a history from somebody with heavy menstrual bleeding.

There are a few key things to ask about in any presentation with a gynecological problem.

And these are the age at menaceae, so the age of the first period, the cycle length,

the days menstruating and the variation in the cycle length, any intermenstrual bleeding

...