HealthCert Insights – A Podcast for Doctors, Nurses and Healthcare Professionals
Sep 13, 2026 · 19 min · 11 segments
Heavy menstrual bleeding is a common presentation in general practice and can have a significant impact on quality of life — and patients are often looking for clear, practical advice. GPs are often…
Simone GonzoGuest
Ask, what is the bleeding stopping you from doing? And if treatment worked well, what would be different? She may prioritize fewer flooding episodes, less pain, avoiding anemia and fatigue, having reliable contraception, preserving fertility, or simply not having to think about tablets.

Many patients arrive with vivid stories from friends, social media, or a previous difficult procedure.

If we launch into a prepared speech, we may answer questions she does not have and miss the one concern driving her decision.

A useful invitation is, what have you heard about hormonal IUDs? And what is your biggest concern? For our 34-year-old patient that we'll be discussing tonight, the goals are lighter bleeding, improved energy as her iron stores recover, and contraception she does not have to remember.

An LNG IUD is reversible, but a patient wanting pregnancy very soon may reasonably choose a shorter-term strategy.

Conversely, a patient wanting both treatment and long-acting contraception may value the combined benefit of an IUD.

For heavy menstrual bleeding, the 52 milligram LNG IUD is the relevant device because the evidence and the Australian standards specifically support it as the most effective medical therapy when there is no malignancy or other significant pathology.

Lower dose hormonal devices are contraceptive options, but they should not be presented as equivalent HMB treatments.

Ask about intermenstrual or post-coital bleeding, new pelvic pain or pressure, abnormal discharge, pregnancy possibility, cervical screening, and the risk factors for endometrial disease.

Examination and imaging are not automatically required for every patient, but they are indicated when history, age, examination or treatment response suggest structural disease or when anatomy may affect placement.

Unexplained abnormal uterine bleeding or concern about malignancy requires investigation rather than simply using the device to suppress the symptom.

Significant distortion of the uterine cavity can affect suitability and placement.

Ask, what is the bleeding stopping you from doing? And if treatment worked well, what would be different? She may prioritize fewer flooding episodes, less pain, avoiding anemia and fatigue, having reliable contraception, preserving fertility, or simply not having to think about tablets.

Many patients arrive with vivid stories from friends, social media, or a previous difficult procedure.

If we launch into a prepared speech, we may answer questions she does not have and miss the one concern driving her decision.

A useful invitation is, what have you heard about hormonal IUDs? And what is your biggest concern? For our 34-year-old patient that we'll be discussing tonight, the goals are lighter bleeding, improved energy as her iron stores recover, and contraception she does not have to remember.

An LNG IUD is reversible, but a patient wanting pregnancy very soon may reasonably choose a shorter-term strategy.

Conversely, a patient wanting both treatment and long-acting contraception may value the combined benefit of an IUD.

For heavy menstrual bleeding, the 52 milligram LNG IUD is the relevant device because the evidence and the Australian standards specifically support it as the most effective medical therapy when there is no malignancy or other significant pathology.

Lower dose hormonal devices are contraceptive options, but they should not be presented as equivalent HMB treatments.

Ask about intermenstrual or post-coital bleeding, new pelvic pain or pressure, abnormal discharge, pregnancy possibility, cervical screening, and the risk factors for endometrial disease.

Examination and imaging are not automatically required for every patient, but they are indicated when history, age, examination or treatment response suggest structural disease or when anatomy may affect placement.

Unexplained abnormal uterine bleeding or concern about malignancy requires investigation rather than simply using the device to suppress the symptom.

Significant distortion of the uterine cavity can affect suitability and placement.
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