Heavy Menstrual Bleeding Flashcards
What is HMB also known as?
Menorrhagia
What is HMB?
Excessive menstrual loss which interferes with a woman’s quality of life
What can cause HMB?
Abnormal uterine bleeding (idiopathic)
Fibroids Endometriosis Adenomyosis PCOS Contraception PID Coagulopathy
What examinations should be done for HMB?
Abdo
- pallor
- palpable mass
Bimanual
- pelvic mass
- adnexal mass
Speculum
- inflamed cervix
- vaginal changes
What are key points in a menstrual history?
Frequency = length of cycle
Duration = how long they bleed for
Volume
- how often they change pad/tampon
- pass any clots
Date of last menstrual period
How should HMB be investigated?
Urine pregnancy test
Bloods
- FBC
+/- TFTs, LH/FSH, clotting screen
Imaging
- USS pelvis if indicated
Outpatient hysteroscopy
Swabs if indicated
How is HMB managed medically if contraception is also wanted?
Mirena coil
COCP
How is HMB managed medically if contraception is not wanted?
Associated pain - mefenamic acid
No pain - tranexamic acid
What is tranexamic acid?
Antifibrinolytic
When is taken tranexamic acid taken?
During menses
What is mefenamic acid?
NSAID
When is mefenamic acid taken?
During menses
How can HMB be managed surgically?
Endometrial ablation
Hysterectomy
What is endometrial ablation?
Endometrial lining of the uterus is obliterated
What is a hysterectomy?
Removal of the uterus
subtotal = just uterus
Total = uterus + cervix
