Menorrhagia

Question 1

What is menorrhagia?

Answer 1

Heavy regular mentruation >80mL per cycle, over several cycles.

Question 2

What is the aetiology of menorrhagia?

Answer 2

Idiopathic (DUB), anovulatory, uterine causes (fibroids, polyp, infection, IUCD, endometrial hyperplasia, endometrial cancer), endocrine causes (hypothyroid), bleeding disorders, antocoagulation.

10-20% of menstruationg women. 12% gynae referrals.

Question 3

What is the Hx/Ex of menorrhagia?

Answer 3

Excessive bleeding. Elicit duration, how much, passing clots, associated dysmenhorrea, symptoms of underlying conditions.

General: anaemia, underlying conditions.

Abdomen: palpable fibroid uterus.

Speculum: assess active bleeding, PV discharge.

Vaginal: uterine size, cervical tenderness (infection)

Question 4

What Ix would you do for menorrhagia?

Answer 4

Blood: FBC (anaemia) TFT, clotting, haematynics

MicrobiologyL HVS, endocervical/Chlamydia swab

Imaging: Pelvic USS (endometrial thickness, fibroids, endometrial polyps).

Tissue diagnosis: pipelle biopsy/hysteroscopy to rule out malignancy in certain groups.

Other: cervical smear.

Question 5

What is the management of menorrhagia?

Answer 5

Medical: Tranexemic acid, mefenamic acid, norethisterone (d5-26).

Surgery: Hysteroscopic resection of polyps/fibroids/cancer. Myomectomy, endometrial ablation, hysterectomy if family complete.

Question 6

What are the complications/ prognosis of menorrhagia?

Answer 6

Anaemia in 10%, disruption of dayly life, may represent malignancy

Majority relieved by treatment. Few require surgery nowadays with IUS .