Menorrhagia Flashcards
1
Q
What is menorrhagia?
A
-heavy menstrual bleeding
2
Q
What is seen as excessive menstrual bleeding (menorrhagia)?
A
- excessive menstrual blood loss involves >80ml loss of blood
- normal loss would be 40ml
- volume of blood loss is rarely measured in practice
3
Q
What is the diagnosis of menorrhagia based on?
A
based on symptoms such as:
- changing pads every 1-2 hours
- bleeding lasting more than 7 days and passing large clots
- diagnosis can be made based on self report of very heavy periods
4
Q
What are causes of menorrhagia?
A
- dysfunctional uterine bleeding (no identifiable cause)
- extremes of reproductive age
- fibroids
- endometriosis and adenomyosis
- PID (infection)
- contraceptives, especially copper coil
- anticoags
- bleeding disorders eg VWD
- endocrine disorders (diabetes and hypothyroid)
- connective tissue disorders
- endometrial hyperplasia or cancer
- PCOS
5
Q
What are key things to ask about in gynae history?
A
- age at menarche
- cycle length, days menstruating and variation
- intermenstrual bleeding and post coital bleeding
- contraceptive history
- sexual history
- possibility of pregnancy
- plans for future pregnancies
- cervical screening history
- migraines
- PMH and DH
- FH and SH
6
Q
What are the investigations for menorrhagia?
A
- pelvic examination with a speculum and bimanual exam–>mainly to assess for fibroids, ascites and cancers
- FBC to look for iron deficiency anaemia
- Outpatient hysteroscopy
- pelvic and transvaginal US
7
Q
What other additional tests might be considered for menorrhagia?
A
- swabs if evidence of infection
- coagulation screen if FH of clotting disorders or periods always been heavy since menarche
- ferritin if anaemic
- TFT if features of hypothyroidsm
8
Q
What is the first thing to do in the management of menorrhagia?
A
- exclude underlying pathology such as anaemia, fibroids, bleeding disorders and cancer
- if causes identified these should be managed initially
- then establish whether contraception is required or accepted by the patient
9
Q
What is the management of menorrhagia when contraception is not accepted by the patient?
A
treatment used during menstruation for symptomatic relief:
- Tranexamic acid if no pain (antifibrinolytic -reduced bleeding)
- Mefenamic acid when there is pain (NSAID - reduced bleeding and pain)
10
Q
What is the management of menorrhagia when contraception is accepted by the patient?
A
- Mirena coil (first line)
- Combined OCP
- Cyclical oral progestogens such as norethisterone
11
Q
What are the options if medical management has failed for menorrhagia?
A
- endometrial ablation
- hysterectomy
