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
- Lifestyle (smoking, alcohol intake)
- Age (> 40years)
- Hereditary factors
- Unopposed estrogen
Other physical symptoms which may indicate pathology
(besides frequent and/or heavy bleeding)
- Post-coital bleeding
- Intermenstrual bleeding
- Pelvic pressure
3 Consider if there is an identifiable (PALM-COEIN3) cause for her HMB
- Leiomyomas (submucosal or other)
- Malignancy & hyperplasia
- Ovulatory dysfunction
- 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
If endocrine cause suspected
Inherited coagulation disorders
If indicated by structured history
To rule out structural cause of HMB
If endometrial pathology suspected
5 Provide reassurance and offer treatment
Treatment of anemia
Medical or surgical treatment
Using the algorithm overleaf
While awaiting further investigation or test results
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.
- Hurskainen R, et al. Acta Obstet Gynecol Scand 2007;86(6):749–57
- Singh S, et al. SOGC Clinical Practice Guideline. J Obstet Gynaecol Can 2013;35(5 eSuppl):S1-S28
- Munro MG, et al. Int J Gynecol Obstet 2011;113(1):3-13
- NICE Heavy Menstrual Bleeding Clinical Guideline 44, 2007.