Heavy menstrual bleeding with anaemia — CCE clinical encounter

Objectives

1. Diagnose HMB by its impact definition and elicit the structured history NICE specifies. ^[21]
2. Exclude pregnancy and cervical pathology before any treatment pathway. ^[21]
3. Order risk-appropriate investigations — FBC mandatory; imaging only where examination or history raises structural suspicion. ^[21]
4. Offer LNG-IUS first-line with honest counselling about six-cycle assessment and bleeding-pattern change. ^{[4] [21]}
5. Treat iron-deficiency anaemia alongside bleeding control and arrange tranexamic acid/NSAID cover meanwhile if needed. ^{[21] [5] [6]}