Heavy Menstrual Bleeding

Clinical Pathways promote evidence based, safe, and high-value care for patients by providing clinical recommendations and standard processes. They are developed by multidisciplinary committees of subject matter experts, informed by methodical review of available evidence and consensus among committee members.

Clinical Pathways:

• Heavy Menstrual Bleeding: ED/UCC Algorithm
• Heavy Menstrual Bleeding: Inpatient Algorithm 
• Heavy Menstrual Bleeding: IV Premarin Algorithm
• Heavy Menstrual Bleeding Synopsis (provides care standards employed for this clinical pathway)

Inclusion and exclusion criteria:

• Inclusion (any of the following):
  • Volume equates to saturating a heavy absorbance pad/tampon more frequently than every 2 hours
  • Excessive menstrual flow in duration of > 7 days
  • Bleeding is causing symptomatic anemia or lifestyle disturbance
  • Bleeding is unlikely to be due to ongoing contraception
• Exclusion:
  • Hormonal bleeding with contraception
  • Pregnancy
  • Trauma
  • Sexual assault
  • Genital injury
  • Known bleeding disorders

Committee members involved in the development:

•    Ashli Lawson, MD, MS | Gynecology | Committee Chair
•    Shannon Carpenter, MD, MS | Hematology/Oncology/BMT | Committee Member 
•    Lauren Amos, MD | Hematology/Oncology/BMT | Committee Member 
•    Erin Scott, DO | Emergency Department | Committee Member 
•    Jeanette Higgins, RN, MSN, CPNP | Gynecology | Committee Member 

EBP Committee Members:

•    Kathleen Berg, MD, FAAP | Hospitalist, Evidence Based Practice 
•    Megan Gripka, MT (ASCP) SM | Evidence Based Practice

Publication dates:

•    Finalized date: 07/2023
•    Next expected revision date: 07/2026

If you have any questions regarding this content or identify a broken link, please email evidencebasedpractice@cmh.edu. 

These pathways do not establish a standard of care to be followed in every case. It is recognized that each case is different, and those individuals involved in providing health care are expected to use their judgment in determining what is in the best interests of the patient based on the circumstances existing at the time. It is impossible to anticipate all possible situations that may exist and to prepare a pathway for each. Accordingly, these pathways should guide care with the understanding that departures from them may be required at times.