Heavy menstrual bleeding

Hypermenorrhea (Hypermenorrhea)

1) Disease Description (Causes and Symptoms)

• Definition: A condition in which menstruation lasts 7 days or longer or the menstrual blood volume in one cycle is excessive at approximately 80 mL or more, resulting in anemia or disruption of daily life.
• Main causes
  • Structural causes: Uterine fibroids (leiomyoma), adenomyosis, endometrial polyps, endometrial hyperplasia, endometrial cancer
  • Bleeding disorders: Coagulation abnormalities such as von Willebrand disease and thrombocytopenia (ITP)
  • Hormonal abnormalities: Anovulatory cycles, 에서rogen/progestin imbalance
  • Other: Cervical lesions, medications (such as anticoagulants), unknown cause (idiopathic)
• Pathophysiology (brief summary): Excessive proliferation of the endometrium or abnormalities in the structure of the uterine muscle layer (fibroids·adenomyosis) may increase menstrual blood loss, while vascular fragility or coagulation disorders may make it difficult to control bleeding.
• Main symptoms: Excessive menstrual bleeding (frequent replacement of pads·tampons), passage of blood clots, dizziness·fatigue·signs of anemia (pallor, palpitations) during menstruation, limitations in daily life·work activities

2) Treatment Methods

• Diagnostic evaluation (before treatment): Anemia testing (CBC), pelvic ultrasound (checking the structure of both ovaries·uterus), coagulation tests (especially vWD testing in cases with a history of bleeding), and, when necessary, endometrial biopsy or hysteroscopy·cervicoscopy
• Medication treatment (general standard)
  • Nonsteroidal anti-inflammatory drugs (NSAIDs, e.g., ibuprofen, mefenamic acid): Reduce menstrual pain and partially reduce blood loss
  • Antifibrinolytic agent (tranexamic acid): Effectively reduces menstrual blood loss (however, caution is required in cases with a risk of thrombosis)
  • Hormone therapy
    • Oral contraceptives (combined oral contraceptives): Reduce periodic blood loss and improve pain
    • Progestin-only therapy (e.g., norethisterone): Used in specific cases
    • Levonorgestrel intrauterine system (LNG-IUS, Mirena, etc.): Highly effective for reducing blood loss over the long term (3–5 years or longer)
    • GnRH agonists: Improve bleeding·anemia through temporary hormonal suppression (short-term use is recommended; side effects include reduced bone mineral density)
• Procedures/Surgery
  • Endometrial ablation: Reduces bleeding but is recommended when future pregnancy is not desired
  • Treatment for uterine fibroids: Myomectomy, uterine artery embolization (UAE), etc.
  • Hysterectomy: Definitive treatment when medication/conservative treatment fails or when a uterine disease (such as cancer) is present
  • Hysteroscopic resection or polypectomy (for endometrial polyps)
• Anemia management
  • Mild anemia: Oral iron supplements
  • Severe anemia: Intravenous iron or transfusion may be considered
• Lifestyle management and other measures
  • Record menstrual volume and duration (number of pad·tampon changes, clot size, etc.)
  • Ensure sufficient iron intake and nutritional management, and get rest
  • If emergency signs occur (a pad·tampon becomes soaked every hour, fainting·dizziness, etc.), visit the emergency room immediately
• Precautions and complications
  • For hormone therapy (especially oral contraceptives), consider risk factors for thrombosis (smoking, hypertension, older age, etc.)
  • Irregular bleeding may occur initially after LNG-IUS insertion
  • Pregnancy is impossible after endometrial ablation/hysterectomy (loss of fertility) — carefully consider the choice of surgery if fertility preservation is desired
  • Long-term complications: Chronic anemia, effects on sexual activity·psychological effects

3) Outpatient Visit Checkpoints (Items to Prepare and Example Questions)

• Items to prepare (recommended to bring)
  • List of medications currently being taken (including prescription drugs·over-the-counter medicines·supplements)
  • Previous test results (pelvic ultrasound, blood tests, etc.) or examination records
  • Menstrual records from the past 3–6 months (duration, number of pad/tampon changes, presence of clots, degree of pain)
  • Past medical history (uterine surgery, bleeding disorders, pregnancy history) and family history (bleeding disorders, uterine cancer, etc.)
• Information to tell the doctor during the outpatient visit (examples)
  • Date menstruation began and its duration, average frequency of pad changes (e.g., how many per hour)
  • Whether recent anemia-related symptoms such as dizziness·fainting·shortness of breath are present
  • Possibility of pregnancy (recent sexual intercourse·contraceptive status)
  • Whether anticoagulants·antithrombotic drugs are currently being taken

4) General Examples of Questions to Ask the Doctor

• "What are the side effects of this medication (e.g., tranexamic acid, oral contraceptives, LNG-IUS)?"
• "How severe is my anemia and what is the prognosis? How long should I take iron?"
• "Do you recommend surgery (hysterectomy, endometrial ablation)? What other alternatives are there?"
• "Once treatment begins, when will my menstrual pattern stabilize? How likely is recurrence?"

5) Examples of Condition-Specific Questions

• If a structural cause (e.g., uterine fibroids) has been confirmed: "I have heavy bleeding because of uterine fibroids. Which would be more suitable for my situation, myomectomy or uterine artery embolization?"
• If pregnancy is desired: "I am planning a pregnancy. What treatment options can safely reduce bleeding? Which treatments affect fertility?"

(Emergency symptoms: If a pad·tampon becomes completely soaked within one hour, or if fainting·severe dizziness·shortness of breath occurs, visit the emergency room immediately)