Menorrhagia

Question 1

Assessment of HMB

Answer 1

• Hx- ask for symptoms of pressure, pelvic pain, hx of fibroids etc
• Impact on QoL
• PMH/surgical hx
• Menstrual cycle
• Examine

Question 2

Blood tests

Answer 2

• Bloods - FBC for all
• Coag if HMB since menarrche or Fhx of clotting disorder

Question 3

Scans

Answer 3

• If dysmenorrhoea
• Bulky uterus on examination
• Consider starting rx wo scan if low risk for fibroids/cavity abnormalities/cancer

Question 4

Hysteroscopy if

Answer 4

• Persistent IMB suggesting polyp/fibroid
• On tamoxifen
• If treatment not worked
• Obesity/PCOS with IMB

Question 5

Causes of HMB

Answer 5

Attach image
PALM
COEIN

Question 6

Mx- expectant

Answer 6

• If does not want hormonal rx, or unreliable hx
• Use mefenamic acid and TXA during periods

Question 7

Mx Medical

Answer 7

• Mirena- Most effective
  Do not offer if fibroids >3cm + distorting cavity
• Other cyclical POP D5-25/COCP
• Depo
• GnRH - only short term

Question 8

Mx- Surgical

Answer 8

• Not 1st line
• Not advised
• Induce 2’ Ashermann syndrome
• UAE/ablation
• Myomectomy for large fibroids

Question 9

When to use ulipristal acetate 5mg

Answer 9

• if not sutiable for/ decline UAE/surgery
• Failed rx for fibroid

Question 10

Complications of UA

Answer 10

• Serious liver injury- needs close monitoring every month