WSF OpenID Connect Login
Training & support
HELP group: improving knowledge, improving lives
The HELP group is a team of international gynecologists specialized in heavy menstrual bleeding (HMB). Their goal is to improve the quality of care for women affected by HMB worldwide.1
The HELP group have created a website to provide a comprehensive educational resource to help you identify and diagnose HMB, as well as counsel on effective therapeutic options. By expanding your patients’ knowledge of HMB, you can have more productive consultations and help find appropriate treatments to improve their lives.1
Click here to visit the HELP HMB website
HELP – Heavy Menstrual Bleeding Evidence-based Learning for best Practice; HMB – heavy menstrual bleeding
- Heavy Menstrual Bleeding. About the HELP group. Available at: https://www.heavymenstrualbleeding.com/professionals/about-us [Accessed February 2021]. Return to content
HELP diagnostic and treatment algorithm: step by step
The HELP group developed a 5-step algorithm to assist you in diagnosing and managing HMB. It includes factors to look out for when taking a medical history, as well as further investigation to consider when selecting an appropriate treatment strategy.1
Establish whether your patient is struggling with HMB
There are three aspects you should assess:
- How much does she bleed (e.g. does she change sanitary protection every 1–2 hours or during the night)?
- Does the bleeding affect her physically (e.g. does she pass large clots or feel faint/breathless during her period)?
- Does her period affect her daily life (e.g. does she organize social activities around her period, or worry about bleeding-related incidents)?
Take a structured medical history and conduct a physical examination
History and examination will provide important information about possible risk factors or symptoms of specific gynecological pathologies.
Risk factors for gynecological pathology can include: age over 40 years, obesity, diabetes, unopposed estrogen and lifestyle factors (such as smoking or alcohol intake). Family history, medications (such as anticoagulants) or copper intrauterine devices are also important factors to consider.
Physical symptoms that may indicate gynecological pathology can include post-coital or intermenstrual bleeding, pelvic pressure or pain.
Determine whether there is an identifiable cause for HMB
For this step, you should consider the causes included in the PALM-COEIN classification.2 It was developed by FIGO and identifies four structural and five non-structural causes of abnormal uterine bleeding.
Conduct further investigation where indicated
These may include laboratory tests (e.g. complete blood count, thyroid function and/or screening for coagulation disorders), imaging examinations (e.g. ultrasound) and endometrial biopsy for histological analysis.
Explain test results to the patient, reassure her and offer appropriate treatment
If anemia is identified, this should be treated with iron supplementation.
Depending on the individual case, it may be necessary to consider interim medical treatments such as NSAIDs while awaiting further investigation or test results.
FIGO – International Federation of Gynecology and Obstetrics; HELP – Heavy Menstrual Bleeding Evidence-based Learning for best Practice; HMB – heavy menstrual bleeding; NSAID – non-steroidal anti-inflammatory drug; PALM-COEIN – polyps, adenomyosis, leiomyomas, malignancy & hyperplasia, coagulopathy, ovulatory dysfunction, endometrial, iatrogenic, not yet specified
- Heavy Menstrual Bleeding. General Diagnosis. Available at: https://www.heavymenstrualbleeding.com/professionals/learn-about-HMB/general-diagnosis [Accessed February 2021]. Return to content
- Munro MG, Critchley HOD, Broder MS et al. Int J Gynaecol Obstet 2011;113(1):3–13. Return to content
7 quick questions to identify women with heavy menstrual bleeding
Identifying HMB can be difficult, especially as many women do not spontaneously mention their bleeding pattern during a consultation. The HELP group provides a list of seven questions on their website that you can walk through with your patient to help you identify whether she is suffering from HMB:1
- Do you have to change your sanitary protection during the night?
- On your heavy days, do you find yourself changing sanitary protection more than once every two hours?
- Do you experience excessively long, frequent and/or unpredictable periods?
- Do you pass large blood clots?
- Do you ever feel faint or breathless during your period?
- Do you organize social activities or plan your clothing around your bleeding?
- Do you worry about having bleeding-related incidents?
HELP – Heavy Menstrual Bleeding Evidence-based Learning for best Practice; HMB – heavy menstrual bleeding
- Heavy Menstrual Bleeding. Questionnaire to identify patients. Available at: https://www.heavymenstrualbleeding.com/professionals/counseling/questionnaire-tool [Accessed February 2021]. Return to content
The PALM-COEIN classification system for abnormal uterine bleeding
FIGO developed the PALM-COEIN classification system to help categorize both structural and non-structural causes of abnormal uterine bleeding.1 When diagnosing HMB, these potential underlying causes should be investigated:
Structural causes |
Non-structural causes |
|---|---|
|
|
FIGO – International Federation of Gynecology and Obstetrics; HMB – heavy menstrual bleeding; PALM-COEIN – polyps, adenomyosis, leiomyomas, malignancy & hyperplasia, coagulopathy, ovulatory dysfunction, endometrial, iatrogenic, not yet specified
- Heavy Menstrual Bleeding. PALM-COEIN Classification. Available at: https://www.heavymenstrualbleeding.com/professionals/learn-about-HMB/PALM-COEIN-Classification [Accessed December 2020]. Return to content
Recommendations
