Heavy Menstrual Bleeding

Question 1

heavy menstrual bleeding
- what?

Answer 1

blood loss that interfered with physical, social, emotional or material aspect of womans life

Question 2

heavy menstrual bleeding
-causes?

Answer 2

Fibroids (20-30%)

Polyps (5-10%)

Adenomyosis (5%)

Coagulopathy (Von Willebrand disease, medications)

Malignancy (endometrial hyperplasia)

Question 3

most common caus eof heavy menstrual bleeding?

Answer 3

fibroids

Question 4

heavy menstrual bleeding
-investigations?

Answer 4

Exclude pregnancy!
History and examination:
-FBC (check for anaemia)
-Cervical smears
-Swabs for infection
-USS (if clinically indicated for polyps or fibroids)

Question 5

first line treatment for heavy menstrual bleeding?

Answer 5

Mirena coil

Question 6

what can decrease chances of endometrium hyperplasia and help with heavy menstrual bleeding?

Answer 6

Mirena coil

Question 7

2nd line treatment for heavy menstrual bleeding?

Answer 7

Tranexamic acid (anti- fibrinolytic) or COC

Question 8

what medication is often given to patients with heavy menstrual bleeding who do not want the hormonal option?

Answer 8

Tranexamic acid (anti- fibrinolytic)

Question 9

3rd line treatment for heavy menstrual bleeding?

Answer 9

1. Norethisterone (prevents proliferatoin of the endometrium)
2. DMPA (depot injection)

Question 10

4th line treatment for heavy menstrual bleeding?

Answer 10

surgical management/ referral to secondary care

Question 11

1st, 2nd, 3rd, 4th line management for heavy menstrual bleeding?

Answer 11

1st line= Mirena coil

2nd line=
1. Tranexamic acid
· Anti- fibrinolytic
· Good for patients who don’t want hormonal option

2. COC
· Suppresses ovulation and endometrial proliferation, regulates cycles

3rd line=
1. Norethisterone

2. DMPA (depot injection)

4th line= surgical management/ referral to secondary care