1. Heavy periods

2. History Before 1990 - 60% ended up with hysterectomy Since 1990 – rapid decrease in hysterectomy Family history May influence patient expectation ICE early

3. Heavy periods Normal or abnormal Treatment or no treatment Who decides? How?

4. Heavy periods - definition HMB – excessive menstrual blood loss which interferes with the woman's physical, emotional, social and material QOL, and which can occur alone or in combination with other symptoms. NICE January 2007

5. Heavy periods The story FBC Examination – if abnormality is suspected or over 45 and treatment fails Need for scan? Options – patient choice (equipoise)

6. Heavy periods First line Second line Third line Up the gynae sleeve IUS Tranexamic acid (antifibriolytic) Antiprostaglandins eg NSAIDS Combined pill Minipill Depo progesterone Gn-RH analogues and HRT after 6 months Surgery