menorrhagia

Question 1

menorrhagia

Answer 1

heavy blood loss over several menstrual cycle

Question 2

causes of menorrhagia?

Answer 2

uterine and pelvic pathologies such as fibroids, carcinoma, polyps.

systemic disorders such as hypothyroidism and iatrogenic factors (medication and intrauterine devices)

Question 3

how should you, arrive at a differential diagnosis?

Answer 3

detailed history of menstrual cycle.

symptom specific question

Question 4

clinical features of heavy menstrual bleeding?

Answer 4

experiencing blood loss more than normal?

bleeding pattern heavier and longer? stains?

Question 5

conditions to eliminate?

Answer 5

medicine induced menstrual bleeding. (anticoagulant, monoaminoxidase inhibitor, phenothiazines, steroids, tamoxifen, thyroid hormones)

Question 6

questions to ask?

8

Answer 6

associated symptoms?

time of bleeding?

pain?

effect on quality of life?

symptoms in relation to normal cycle?

have you had this before?

did you try to treat it?

dx?

pmHx?

Question 7

if it is medically induced, what should you do?

Answer 7

contact the prescriber to see if another medication could be given

Question 8

when to refer?

Answer 8

intermenstrual bleeding, post coital bleeding, pelvic pain (signalling cervical or endometrial cancer)

Question 9

treatment?

Answer 9

tranexamic acid.

Question 10

WHY ASK:

associated symptoms?

time of bleeding?

pain?

effect on the quality of life?

symptoms in relation to normal cycle?

have you had this before?

did you try to treat it?

dx?

pmHx?

Answer 10

associated symptoms? intermenstrual bleeding, post coital bleeding, pelvic pain (signalling cervical or endometrial cancer)

time of bleeding? symptoms that might suggest structural or pathological abnormality, including bleeding at times other than menses.

pain? not associated with pain refer if any pain is reported

effect on quality of life? an assessment should be made to determine what effect menstrual bleeding is having on the patient.

symptoms in relation to normal cycle? patient will show cycle to cycle variation with the amount of blood lost, it is important to discuss this normal variation with the patient, and to determine from the patient whether blood loss is within the normal range.

have you had this before?

did you try to treat it? treatment failure could signify something more serious and should be referred.

dx? to see if it is medically induced

pmx?