General diagnosis of HMB –
The HELP Diagnostic Algorithm
The HELP diagnostic algorithm consists of five steps to assist you in diagnosing and managing HMB in your patients.
1 Establish if HMB is a problem for this woman
How much does she bleed?
- Changes sanitary protection during the night
- On her heavy days, changes sanitary protection<2 hours
- Experiences excessively long, frequent and/or unpredictable periods
Does it affect her physically?
- Passes large blood clots
- Feels faint or breathless during her period
Does her monthly bleeding affect her daily life?
- Organizes social activities or plans clothing around menstrual bleeding
- Worries about having accidents related to bleeding
Does one or more of the above apply, and have the symptoms been occurring for 3+ months?
If yes, HMB is impacting negatively on quality of life. Take further action to identify cause and appropriate treatment options.
2 Take a structured medical history and conduct physical examination
What do you need to consider?
Potential factors contributing to presence of HMB
- Obesity
- Diabetes
- Lifestyle (smoking, alcohol intake)
- Age (> 40years)
- Hereditary factors
- Medications
- Unopposed estrogen
- Anovulation
Other physical symptoms which may indicate pathology
(besides frequent and/or heavy bleeding)
- Post-coital bleeding
- Intermenstrual bleeding
- Pelvic pressure
- Pain
3 Consider if there is an identifiable (PALM-COEIN3) cause for her HMB
Structural causes
- Polyps
- Adenomyosis
- Leiomyomas (submucosal or other)
- Malignancy & hyperplasia
NON-Structural causes
- Coagulopathy
- Ovulatory dysfunction
- Endometrial
- Iatrogenic
- Not yet specified
For the majority of women, there is no identifiable cause of HMB4
4 Conduct further investigations where indicated
Complete blood count
Required for all women
Thyroid function
If endocrine cause suspected
Inherited coagulation disorders
If indicated by structured history
Ultrasound scan
To rule out structural cause of HMB
Endometrial biopsy
If endometrial pathology suspected
5 Provide reassurance and offer treatment
Treatment of anemia
If present
Medical or surgical treatment
Using the algorithm overleaf
Interim treatment
While awaiting further investigation or test results
Diagnostic Algorithm
The algorithm covers the essentials of diagnosing and treating HMB, including which factors to look out for when taking a medical history as well as further investigations to consider and a flow diagram to aid you in selecting an appropriate treatment strategy.
PALM COEIN
PALM-COEIN Classification: Causes and treatment of HMB
Learn more about the structural and non-structural causes of HMB as well as suitable treatment approaches.
HMB Teaching and Resources Library
Find informative content such as guidelines, publications and images covering a range of HMB topics for educational use or your daily practice.
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