Gynaecology - Menorrhagia

Question 1

Menorrhagia?

Causes?

Answer 1

Remember as U BLEED:

U - Uterine Polyps/Fibroids

B - Bleeding disorders (Von Willebrand disease - factor VIII clotting factor missing)

L - Likely no underlying pathology (50%)

E - Endometriosis

E - Endometrial carcinoma

D - PID/ intrauterine device

Question 2

Menorrhagia?

Investigations?

Answer 2

General blood tests: FBC, U&Es, TFTs

Radiology: USS, Hysteroscopy,endometrial biopsy

Question 3

Menorrhagia?

Treatment?

Answer 3

Treatment is stepwise approach:

Medical:

• 1st line: Mirena IUD
• 2nd line:mefenamic acid, tranexamic acid, combined oral pill
• 3rd line: long acting progesterons (oral/injected) Consider GnRH analogues if this fails

Surgical:

• Endometrial ablation
• Hystroscopy