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?
Does it affect her physically?
Does her monthly bleeding affect her daily life?
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
Other physical symptoms which may indicate pathology
(besides frequent and/or heavy bleeding)
3 Consider if there is an identifiable (PALM-COEIN3) cause for her HMB
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.