Menorrhagia

Question 1

Define menorrhagia

Answer 1

Menorrhagia is a clinical condition defined as excessive blood loss during a menstrual period to an extent that it substantially affects a woman’s quality of life

Question 2

How common is menorrhagia

Answer 2

Menorrhagia is a common gynecological complaint. In about half of cases, no underlying pathology is found, and the condition is referred to as dysfunctional uterine bleeding.

Question 3

What are local causes of menorhagia?

Answer 3

Fibroids
Adenomyosis
Endometrial polyps
Endometriosis
Pelvic inflammatory disease
Endometrial cancer (be highly suspicious of this if there is postmenopausal bleeding)

Question 4

What are systemic causes of menorrhagia?

Answer 4

Bleeding disorders
Hypothyroidism
Liver and kidney disease
Obesity

Question 5

What are 4 potential differentials?

Answer 5

Fibroids: Often asymptomatic, but can cause heavy or prolonged periods, pelvic pain or pressure, and frequent urination.

Adenomyosis: Symptoms can include prolonged, heavy menstrual bleeding, severe menstrual cramps, and pain during intercourse.

Endometrial polyps: Can cause irregular menstrual bleeding, bleeding between periods, excessively heavy periods, or postmenopausal bleeding.

Endometrial cancer: Symptoms include abnormal vaginal bleeding, pelvic pain, and pain during intercourse.

Question 6

What investigations should be conducted?

Answer 6

FBC + Iron studies: Rule out anaemia
Clotting screen
TVUS to find endometrial polyps/fibroids
Additional tests for endocrine disorders (TFTs)

Question 7

If the cause is dysfunctional uterine bleeding, how is it treated?

Answer 7

Mirena® coil
Mefenamic acid
Tranexamic acid
Hormonal contraception e.g., the combined oral contraceptive pill
In rare cases refractory to medical management, endometrial ablation or hysterectomy may be considered.