This episode makes reference to guidelines produced by the "National Institute for Health and Care Excellence" in the UK, also referred to as "NICE". Please note that the content on this channel reflects my professional interpretation/summary of the guidance and that I am in no way affiliated with, employed by or funded/sponsored by NICE. My name is Fernando Florido and I am a General Practitioner in the United Kingdom. In this episode I will go through the NICE guideline on “Heavy menstrual bleeding: assessment and management”, or NICE guideline [NG88. I will summarise the guidance from a Primary Care perspective only. I am not giving medical advice; this video is intended for health care professionals; it is only my interpretation of the guidelines and you must use your clinical judgement.   There is a YouTube version of this and other videos that you can access here:    The Practical GP YouTube Channel: https://youtube.com/@practicalgp?si=ecJGF5QCuMLQ6hrk The NICE guideline NG88 “Heavy menstrual bleeding: assessment and management” can be found here: ·      https://www.nice.org.uk/guidance/ng88/chapter/Recommendations The Menorrhagia mind map or flow chart can be downloaded here: ·      https://1drv.ms/i/s!AiVFJ_Uoigq0mFegr4-vdKdhitAI?e=BJRIDK Thumbnail photo: from Freepik: https://www.freepik.com/ ·      Image by benzoix on Freepik ·      a href="https://www.freepik.com/free-photo/young-woman-with-pain-stomach-holding-hands-belly-feeling-terrible-ache-menstrual-cramps-stand_34232826.htm#query=heavy%20periods&position=17&from_view=search&track=ais"Image by benzoix/a on Freepik Intro / outro music: Track: Halfway Through — Broke In Summer [Audio Library Release]     Music provided by Audio Library Plus  Watch: https://youtu.be/aBGk6aJM3IU Free Download / Stream: https://alplus.io/halfway-through Transcript Hello and welcome, I am Fernando, a GP in the UK. Today, we will go through the NICE guideline on menorrhagia or, to be precise, “Heavy menstrual bleeding: assessment and management” and I will summarise the guidance from a Primary Care perspective only. So, let’s jump into it. We will obviously start with the history including the nature and impact of the bleeding and we will particularly pay attention to what NICE refers to as “related symptoms”. These are symptoms such as: ·      Persistent intermenstrual bleeding ·      Pelvic pain and/or ·      Pressure symptoms, because they might suggest a uterine abnormality. What may come as a surprise is that NICE says that if none of these symptoms are present, that is, no IMB, no pain and no pressure symptoms, we will consider pharmacological treatment without necessarily carrying out a physical examination. But the converse is true, a physical examination is recommended if such symptoms exist or if we are considering a levonorgestrel-releasing intrauterine system [LNG IUS], that is, a Mirena coil or similar.  In terms of blood tests: ·      we will perform a FBC for all patients and ·      we will consider testing for coagulation disorders if they have had heavy periods since they started and there is a personal or family history suggestive of it ·      However, NICE says that there is no need for routine ferritin, hormone or thyroid testing We will then consider investigations for the cause of the HMB but We will also consider starting pharmacological treatment without investigating the cause if we feel that there is a low risk of uterine abnormality. If we do investigate further, we will consider the need for: ·      Hysteroscopy ·      A pelvic USS or ·      A transvaginal USS And we will choose each investigation depending on whether we suspect: ·      submucosal fibroids, polyps or endometrial pathology (in which case a hysteroscopy would be needed) ·      larger fibroids (in which case a pelvic USS would be needed) or