Gyn - Dysfunctional uterine bleeding

Question 1

45-year-old Madam A, para 2, with sterilization done 10 years ago, presented with menorrhagia
for 6 months. The menstrual pattern is shown on the pictorial chart [regular menstruation, ~10 pads per day,
with clot and flooding sensation, pelvic pain during menstruation]
The general physical examination was normal and the bimanual examination showed a normal size uterus which was mobile and non-tender.
Describe the pictorial chart and give diagnosis)

Answer 1

This is a pictorial chart of patient done in time, showing menorrhagia.

The diagnosis is dysfunctional uterine bleeding due to regular cycle length and negative physical findings.

Question 2

Further Ix?

Answer 2

CBC and iron profile for iron deficiency anemia.
Endometrial sampling
Pap smear
USG

Question 3

Management plan?

Answer 3

First line: transamin, mefenamic acid +/- iron tablets

Second line: mirena

Others: COC, endometrial ablation, hysterectomy