Heavy Menstrual Bleeding Flashcards
What is another name for heavy menstrual bleeding?
Menorrhagia
What is the average volume of blood loss during menstruation?
40ml
What blood loss volume is defined as excessive?
> 80ml
What is the definition of heavy menstrual bleeding?
It is defined as an amount of blood loss that the woman considers to be excessive
The volume of blood loss is rarely measured in clinical practice
What are the nine causes of heavy menstrual bleeding?
Endometrial Polyp
Adenomyosis & Endometriosis
Leiomyoma (Fibroid)
Endometrial Malignancy
Coagulation Disorders (Von Willebrand Disease)
Polycystic Ovarian Syndrome
Pelvic Inflammatory Disease
Anticoagulant Medications
Intrauterine Contraceptive Devices
What are the three clinical features of heavy menstrual bleeding?
Frequent pad changing every one to two hours
Passage of blood clots
Leakage of blood through clothes
What are the five investigations used to detect the underlying cause of heavy menstrual bleeding?
Pregnancy Test
Blood Tests
Ultrasound Scan
Vaginal Swab
Hysteroscopy
When do we conduct a pregnancy test when patients present with heavy menstrual bleeding?
In all patients of a reproductive age
Why is a pregnancy test used to investigate heavy menstrual bleeding?
Vaginal bleeding may indicate miscarriage pregnancy and ectopic pregnancy
What two blood tests used to investigate heavy menstrual bleeding?
Full Blood Count
Coagulation Screen
Why is a FBC test used to investigate heavy menstrual bleeding?
Anaemia, which is a common complication of heavy menstrual bleeding
Why is a coagulation screening test used to investigate heavy menstrual bleeding?
It is used to look for coagulation disorders
When do we conduct a coagulation screening blood test when patients present with heavy menstrual bleeding?
Those with a family history
Those that have experienced heavy menstrual bleeding since menarche
What investigation is the most useful for heavy menstrual bleeding?
Transvaginal US
When do we conduct an US when patients present with heavy menstrual bleeding?
If there is a palpable pelvic mass
If there is pelvic pain on examination
Why do we conduct a vaginal swab to investigate heavy menstrual bleeding?
To assess for infection
When do we conduct a vaginal swab when patients present with heavy menstrual bleeding?
If the patient presents with abnormal discharge
There is a suggestive sexual history
When do we conduct a hysteroscopy when patients present with heavy menstrual bleeding?
If there is an ultrasound pathology identified
When the results of the ultrasound are inconclusive
What are the four pharmacological managements used for heavy menstrual bleeding?
Levonorgestrel Intrauterine System
Tranexamic Acid
Mefenamic Acid
Progesterone Only Pill
What is the first line treatment option for individuals who have heavy menstrual bleeding and want contraception?
Levonorgestrel intrauterine system
What class of drug is tranexamic acid?
Antifibrinolytic drug
What is the role of antifibronyltic drugs?
To improve blood clotting
How is tranexamic acid prescribed for heavy menstrual bleeding?
It is taken only during menses
When is tranexamic acid used to treat heavy menstrual bleeding?
It is a common treatment option for those who are not experiencing any pain and don’t want contraception
What class of drugs is mefenamic acid?
NSAID
How is mefenamic acid prescribed for heavy menstrual bleeding?
It is taken only during menses
When is mefenamic acid used to treat heavy menstrual bleeding?
It is a common treatment option for those who are experiencing pain and don’t want contraception
What specific progesterone only pill is used to treat heavy menstrual bleeding?
Norethisterone
How is the progesterone only pill prescribed for heavy menstrual bleeding?
It can be prescribed three times daily from day 5 – day 26 of the menstrual cycle
This does not work as a contraceptive when taken in this manner
What are the two surgical treatments for heavy menstrual bleeding?
Endometrial Ablation
Hysterectomy
What is endometrial ablation?
It is a procedure in which the endometrium lining of the uterus is obliterated
When are surgical treatments used to treat heavy menstrual bleeding?
When pharmacological management has failed, and the patient no longer wants to conceive
What is a hysterectomy?
A procedure in which the uterus is removed
What is the only definitive treatment option for heavy menstrual bleeding?
Hysterectomy
