Menorrhagia

Question 1

What is this describing?
Excessive menstrual blood loss interfering with woman’s health and quality of life. Can happen with other symptoms or alone.

Answer 1

Menorrhagia

Question 2

What are the causes of menorrhagia?

Answer 2

1. Dysfunctional uterine bleeding - diagnosis of exclusion
2. Uterine fibroids/polyps
3. Adenomyosis
4. Coagulation disorders
5. Hypothyroidism
6. IUD
7. Ovarian/endometrial/cervical malignancy

Question 3

What is this a presentation of?
Heavy, prolonged vaginal bleeding, worse at extremes of productive life. Dysmenorrhoea, flooding and passing of large clots. Anaemia.

Answer 3

Menorrhagia

Question 4

How is menorrhagia investigated?

Answer 4

1. Exclude pregnancy
2. FBC, haematinics, clotting, TFTs
3. Transvaginal USS to exclude structural causes
4. Endometrial biopsy in >40 years, or young women with bleeding non-responsive to medical therapy for endometrial cancer

Question 5

What is the medical management for menorrhagia?

Answer 5

1. Exclude local/systemic causes and malignancy.
2. If trying to conceive - tranexamic acid during bleeding, mefenamic acid also if painful.
3. If not trying to conceive - Mirena IUS, 2nd line COCP, 3rd line IM progestogens

Question 6

What is the surgical management of menorrhagia?

Answer 6

1. Hysteroscopic polyp removal
2. Transcervical resection of fibroid (TCRF) if under 3cm
3. Uterine artery embolisation/myomectomy if over 3cm
4. Endometrial ablation - still need contraception
5. Hysterectomy as a last resort