HMB - menorrhagia management Flashcards
How was heavy menstrual bleeding (menorrhagia) previously defined?
Heavy menstrual bleeding was previously defined as total blood loss > 80 ml per menses.
How is heavy menstrual bleeding currently assessed?
Heavy menstrual bleeding is currently assessed based on what the woman considers to be excessive.
How has the treatment approach for heavy menstrual bleeding changed since the 1990s?
The treatment approach for heavy menstrual bleeding has shifted from many women undergoing hysterectomy to more conservative management options.
What does the management of menorrhagia depend on?
The management of menorrhagia depends on whether a woman needs contraception.
What investigation should be performed in all women with heavy menstrual bleeding?
A full blood count should be performed in all women with heavy menstrual bleeding.
When should a routine transvaginal ultrasound scan be arranged according to NICE?
A routine transvaginal ultrasound scan should be arranged if symptoms suggest a structural or histological abnormality, such as intermenstrual or postcoital bleeding, pelvic pain, and/or pressure symptoms, or abnormal pelvic exam findings.
What are the medication options for women with heavy menstrual bleeding who do not require contraception?
Medication options for women who do not require contraception include mefenamic acid 500 mg tds or tranexamic acid 1 g tds, both started on the first day of the period.
What is the first-line treatment for heavy menstrual bleeding if contraception is required?
The intrauterine system (Mirena) should be considered first-line for managing heavy menstrual bleeding if contraception is required.
What are other contraception options for managing heavy menstrual bleeding?
Other contraception options for managing heavy menstrual bleeding include the combined oral contraceptive pill and long-acting progestogens.
What medication can be used as a short-term option to rapidly stop heavy menstrual bleeding?
Norethisterone 5 mg tds can be used as a short-term option to rapidly stop heavy menstrual bleeding.
