heavy menstrual bleeding

Question 1

technical term for it

Answer 1

menorrhagia

Question 2

what is menorrhagia

Answer 2

excessive menstrual blood loss of 80ml or more, and/or for duration of more than 7 days, which results in the need to change menstrual products every 1-2hours
heavy menstrual bleeding occurs regularly, every 24-35 days

Question 3

choice of treatment needs to be guided by…

Answer 3

presence/asbrsbece of fibroids (including size, number, location)
polyps
endometrial pathology or adenomyosis
other symptoms e.g. pressure or pain
comorbids
pt pref

Question 4

1st line in females with heavy menstrual bleeding and unidentified pathology, fibroids less than 3 cm in diameter causing no distortion of the uterine cavity, or suspected or diagnosed adenomyosis

& what to counsel them on

Answer 4

levonorgestrel relating IUS
Patients should be advised that irregular menstrual bleeding can occur particularly during the first months of use and that the full benefit of treatment may take at least 6 months.

Question 5

If a levonorgestrel-releasing intrauterine system is unsuitable for emales with heavy menstrual bleeding and unidentified pathology, fibroids less than 3 cm in diameter causing no distortion of the uterine cavity, or suspected or diagnosed adenomyosis, offer

Answer 5

either tranexamic acid, an NSAID, a combined hormonal contraceptive, or a cyclical oral progestogen

Question 6

why may progestogen-only contraceptives be useful in pt with heavy menstrual bleeding

Answer 6

Progestogen-only contraceptives may suppress menstruation and be beneficial to females with heavy menstrual bleeding.

Question 7

In females with fibroids of 3 cm or more in diameter, consider

Answer 7

consider referral to specialist

Question 8

treatment options in females with fibroids of 3 cm or more in diameter (treatment choice depends on size, number and location of fibroids)

Answer 8

Treatment options include tranexamic acid, an NSAID, a levonorgestrel-releasing intrauterine system, a combined hormonal contraceptive, a cyclical oral progestogen, ulipristal acetate, uterine artery embolisation, or surgery.

Question 9

if drug treatment is required while investigations and definitive treatment is being organised for females with fibroids of 3 cm or more in diameter, offer

Answer 9

either tranexamic acid, or an NSAID, or both, can be given

Question 10

what can you give to treat moderate to severe symptoms of uterine fibroids in premenopausal women where surgery and uterine artery embolisation are unsuitable, or have failed

Answer 10

Intermittent ulipristal acetate

Question 11

effectiveness of drug treatment for heavy menstrual bleeding may be limited in females with fibroids that are

Answer 11

substantially greater than 3 cm in diameter.

Question 12

Treatment with a ……… before hysterectomy and myomectomy should be considered if uterine fibroids are causing an enlarged or distorted uterus.

Answer 12

gonadotrophin-releasing hormone analogue