Heavy Menstrual Bleeding & Dysmennorrhea

Question 1

What investigations are required in heavy menstrual bleeding?

Answer 1

FBC for all women
Clotting profile only if HMB since periods began or personal or family history suggestive of a bleeding disorder

Question 2

What is the medical management of HMB?

Answer 2

If contraception required -> Mirena is first line, COCP is second line
If contraception not required -> TXA, Mefenamic acid is useful if dysmenorrhoea also present

Question 3

What are the most common locations for endometrial deposits?

Answer 3

Ovaries, uterosacral ligaments and Pouch of Douglas.

Question 4

What is the gold standard for diagnosing endometriosis?

Answer 4

Laparoscopy

Question 5

When can the IUS be used in women with fibroids?

Answer 5

Fibroids less than 3cm in size and not distorting the uterine cavity

Question 6

What is the management of primary dysmennorhoea?

Answer 6

NSAIDs (Ibuprofen, Mef)
COCP

Question 7

What is the management of secondary dysmennorhoea?

Answer 7

Refer to Gynae

Question 8

Which medication can be used pre-operatively to reduce the size of fibroids?

Answer 8

GnRH agonists e.g. Goserelin