Menorrhagia Flashcards
What is menorrhagia according to NICE?
Excessive blood loss interferes with the physical, social, emotional and/or material quality of life
What are causes of menorrhagia?
Polyp
Adenomyosis
Leiomyoma
Malignancy or hyperplasia
Coagulopathy
Ovulatory disorder
Endometrial (poorly understood)
Iatrogenic
Non-specified
What is a polyp?
overgrowth of endometrial glands and stroma
What is adenomyosis?
presence of non-neoplastic endometrial glands and stroma in myometrium
hypertrophy and hyperplasia of the myometrium
How is adenomyosis diagnosed?
UUS or MRI
What are risk factors for adenomyosis?
High parity
CS birth
(smoking helps)
What is leiomyoma?
smooth muscle tumour of uterus
What are risk factors for malignancy?
Obesity
PCOS (unopposed oestrogen)
Nullparity
Tamoxifen
FH breast/colon/endometrial cancer
DM
HTN
What is the most common coagulopathy causing menorrhagia?
von Willebrand
How does ovulatory causes lead to menorrhagia? Give examples
Unopposed oestrogen, infrequent cycles, overgrowth of endometrium leading to bleeding e.g. PCOS, hyperprolactinaemia, hypothyroidism
What are iatrogenic causes of menorrhagia?
Mirena
COCP
HRT
Anti-coagulants e.g. warfarin
What are non-classified causes of menorrhagia?
AV malformations
CS niche
What are fibroids?
Uterine leiomyoma - benign tumours of the smooth muscle of the womb
How are fibroids classified?
Subserosal – on outside of uterus
Intramural – within muscle of uterus
Submucosal – impinging on cavity of the uterus
Pedunculated – on a stem, usually referring to outside of uterus
Intracavitary – on stem within cavity of uterus
What are endometrial polyps?
Hyperplastic localised overgrowth of endometrial glands and stroma - can affect fertility
What are investigations for menorrhagia? Why?
Hysteroscopy - suspected submucosal fibroids, polyps, endometrial pathology
Pelvic ultrasound - suspected largery fibroids or adenomyosis
What are treatments for menorrhagia?
Tranexamic acid
LNG-IUS
Endometrial ablation
Hysterectomy
What is tranexamic acid in treatment of menorrhagia?
NSAID
500mg -1g tds PO while bleeding – up to 5 days
Can cause stomach irritation
Can be used long-term
What is LNG-IUS in treatment of menorrhagia?
Mirena, Kyleena, Jaydess
Lifespan – 3-5 years
May have irregular bleeding for the first few months (up to 6 months)
(Not all LNG-IUS licensed for treatment of menorrhagia)
What is endometrial ablation in treatment of menorrhagia?
Radiofrequency thermal ablation of endometrium
Significantly affects fertility but need to use contraception as well
What is hysterectomy in treatment of menorrhagia?
Surgery of last resort - removal of uterus
What are risks associated with hysterectomy?
Risk of intraoperative haemorrhage
Risk of damage to other organs – bowel, bladder, ureters
Risk of loss of ovarian function after surgery
Risk of impact on sexual feelings
