Advising patients with HMB

How  to have a conversation with women with HMB 

Pharmacy teams can play a key role in identifying and helping women with HMB

It is important to recognise that due to HMB’s perceived normality, some women will not raise the issue and the pharmacy team should be alert to cues that could act as a prompt to open the conversation:

• Buying large quantities of sanitary products
• Doubling up on sanitary products, e.g. heavy flow tampons and pads
• Requests for strong analgesics to manage period pain
• If the patient has signs or symptoms of iron deficiency anaemia.

The key priority in helping women with HMB is to take their concerns seriously, and to listen and provide reassurance.⁴

Firstly, in validating their condition is worthy of intervention and management. HMB is a common gynaecological complaint, so sufferers often don’t feel it needs to be investigated or treated as they believe it’s normal. ^4,5

Secondly, if they are concerned that their symptoms are a sign of a serious cancer condition, they can be reassured that the risk is negligible.¹⁸ Check that the patient does not have any symptoms that warrant referral, such as pelvic mass or unexplained weight loss.⁹ 

Thirdly, that there are effective and well-tolerated treatment options, such as Evana, that can help reduce menstrual blood loss by up to 60%.⁷

Dose

• Start Evana only once heavy bleeding has started⁶
• Take 2 tablets 3 times daily i.e. 6 tablets (3g) for a maximum of 4 days.⁶
• The dose can be increased to a maximum of 4x daily i.e., 8 tablets (4g) if menstrual bleeding is very heavy.⁶

Duration

• It may take using Evana for three menstrual cycles before they experience the full benefit on their blood flow.⁶
• If Evana is successful in reducing blood flow, it can continue to be used for as long as periods remain regular and heavy,⁶ following a review of the Pharmacy Supply Model.
• If there is no reduction in menstrual blood flow after three menstural cycles, Evana should be stopped and the patient should see their GP.⁶

Deficiency

• Be alert and ask about symptoms of iron deficiency anaemia, as this is common among patients with HMB.³ These include fatigue, breathlessness, headache, restless leg syndrome and cognitive dysfunction.⁹
• Advise the patient that iron supplements can be purchased from pharmacy and that if iron deficiency symptoms do not improve then they should see their doctor for further advice.