Websites on heavy menstrual bleeding

Dr Keith Barnard recommends websites related to this week's Clinical Review.

Assessing flow
What constitutes heavy menstrual bleeding may often be in the eyes of the patient.

The perceived severity of menstrual blood loss correlates poorly with objective measurements, but we should be flexible, because if a woman's emotional, working or social quality of life is impaired by the degree of menstrual loss, then it is important to her even if it does not meet strict laid-down criteria.

History is all important, and usually the diagnosis is made on subjective grounds, but a pictorial blood-loss assessment chart is an alternative option to support diagnosis.

It scores the degree to which each sanitary protection item is soiled with blood - as well as the presence of clots - and correlates reasonably well with objectively measured menstrual blood loss.

To find such a chart and read how to use it, this is the place to go - for obvious reasons, it is best printed out in colour.

Why go there: a simple aid.
Downside: none.
Information from: The Haemophilia Society.
Address: www.womenbleedtoo.org.uk/User_Files/PBACchart.doc

Endometrial ablation
My own view based on anecdotal evidence from patients is that endometrial ablation can transform lives from embarrassed misery to complete normality, but you should know a little more than that.

You will not need to digest all of this extensive review, but it is worth skipping through the pages to read about the different techniques.

What is really good is that each method is colourfully illustrated so you can grasp the basic principles without reading every word.

It comes from Australia, so is not 100 per cent transferable to the UK, but you will still find it of value.

Why go there: see the various techniques.
Downside: rather long.
Information from: University of New South Wales, Australia.
Address: www.pta.net.au/sgeg/endo/GlobalAblation.htm

Patient Information
The mobile phone advertisements may be a little distracting, but this account of heavy periods is sensible, clear and helpfully illustrated.

It is quite long, and you will need an attention span greater than the average Big Brother contestant to gather the most from it.

I do not think that, of the surgical options, hysterectomy should come first, as this rather suggests that referral to a gynaecologist means you can kiss your womb goodbye. This might put some women off seeking a surgical opinion, when the reality is far from this.

Why go there: good, comprehensive advice.
Downside: the advertising.
Information from: Patient UK.
Address: www.patient.co.uk/showdoc/23068954/

Dr Barnard is a former GP in Fareham, Hampshire

Website of the week
I often say unkind things about NICE, but here is a quick guide that is bang up to date, easy to find and not too complicated. You really only need to look at pages 3-10. They are packed with good stuff, including an excellent flowchart that they call a 'care pathway', but to me that raises the question of whether there is a 'don't care pathway' - maybe I'm being picky.

There are also tables of pharmacological and surgical treatment, and I particularly like the page that tells you which investigations are a waste of time. These include menstrual blood loss measurements, female hormone testing, and the old favourite, a D&C.

Why go there: current, brief, authoritative.
Downside: none.
Information from: NICE.
Address: Please click here

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