Heavy menstrual bleeding - Information provision

Question 1

Levonorgestrel-releasing intrauterine system information for patients

Answer 1

• Common: irregular bleeding that may last for over 6 months; hormone-related problems such as breast tenderness, acne or headaches, which, if present, are generally minor and transient
• Less common: amenorrhoea
• Rare: uterine perforation at the time of insertion

Question 2

Tranexamic acid info for pts

Answer 2

Less common: indigestion; diarrhoea; headaches

Question 3

Non-steroidal anti-inflammatory drugs info for pts

Answer 3

• Common: indigestion; diarrhoea

- Rare: worsening of asthma in sensitive individuals; peptic ulcers with possible bleeding and peritonitis

Question 4

Combined oral contraceptives info for pts

Answer 4

• Common: mood changes; headaches; nausea; fluid retention; breast tenderness
• Very rare: deep vein thrombosis; stroke; heart attacks

Question 5

Oral progestogen (norethisterone) info for pts

Answer 5

• Common: weight gain; bloating; breast tenderness; headaches; acne (but all are usually minor and transient)
• Rare: depression

Question 6

Injected progestogen info for pts

Answer 6

• Common: weight gain; irregular bleeding; amenorrhoea; premenstrual-like syndrome (including bloating, fluid retention, breast tenderness)
• Less common: small loss of bone mineral density, largely recovered when treatment discontinued

Question 7

Gonadotrophin-releasing hormone analogue info for pts

Answer 7

• Common: menopausal-like symptoms (such as hot flushes, increased sweating, vaginal dryness)
• Less common: osteoporosis, particularly trabecular bone with longer than 6-months’ use

Question 8

Endometrial ablation info for pts

Answer 8

• Common: vaginal discharge; increased period pain or cramping (even if no further bleeding); need for additional surgery
• Less common: infection
• Rare: perforation (but very rare with second generation techniques)

Question 9

Uterine artery embolisation info for pts

Answer 9

• Common: persistent vaginal discharge; post-embolisation syndrome – pain, nausea, vomiting and fever (not involving hospitalisation)
• Less common: need for additional surgery; premature ovarian failure particularly in women over 45 years old; haematoma
• Rare: haemorrhage; non-target embolisation causing tissue necrosis; infection causing septicaemia

Question 10

Myomectomy info for pts

Answer 10

• Less common: adhesions (which may lead to pain and/or impaired fertility); need for additional surgery; recurrence of fibroids; perforation (hysteroscopic route); infection
• Rare: haemorrhage

Question 11

Hysterectomy info for pts

Answer 11

• Common: infection
• Less common: intraoperative haemorrhage; damage to other abdominal organs, such as the urinary tract or bowel; urinary dysfunction – frequent passing of urine and incontinence
• Rare: thrombosis (DVT and clot on the lung)
• Very rare: death
  (Complications are more likely when hysterectomy is performed in the presence of fibroids.)

Question 12

Oophorectomy at time of hysterectomy info for pts

Answer 12

Common: menopausal-like symptoms