Menorrhagia Flashcards
What is menorrhagia?
Amount?
subjectively heavy menses
normal = 30-80ml
therefore higher then 80ml or 10+ pads daily
Causes of heavy bleeding?
Dysfunctional uterine bleed
Fibroids
IUD (Copper coil)
Hypothyroidism (low T4)
MC idiopathic
Dx for menorrhagia?
Bloods - FBC, Clotting screen, ferritin, TFTs
TV USS - Hx and exam
What are fibroids?
Who do they affect?
what % of child bearing females suffer from them?
Uterine leimyoma (uterine smooth muscle benign growth)
In 30-50 y/o Females
20-50%
RF for fibroids?
High oestrogen
due to nulliparity, obesity, early menarche, late menopause, afrocarribean
what are the 4 types of fibrous and where are they located?
Pedunculated - grow on long stalk
Subserosal - grow outside the uterus
intramural - grow in the wall of the uterus
Submuscosal - grow under lining of uterus
Sx of fibroids?
Menorrhagia
bloating
pelvic pressure
Subfertility
what risk do fibroids pose to a foetus?
risk of IUGR
Abnormal foetal lie
Dx of fibroids?
Abdo exam - central large mass
Bimanual exam - large
irregular non tender uterus
TV USS - Mass
Could also do MRI
If the fibroid was cut out and dissected, what would be seen?
whoried appearance
What is the Tx for fibroids?
Contraception YES:
1. IUS (progesterone secreting coil)
2. COCP
Contraception NO:
1. Tranexamic acid
What is an IUS contraindicated in?
uterus is distorted
What is TXA?
Type of NSAID That reduces blood loss
what is specialist Tx for fibroids?
GnRH analogue
uterine artery embolisation
If you have a subfertile female with fibroids that wants to have a child, what is the best course of action?
have a myomectomy (remove the fibroid)
What would be given pre surgically and why?
GnRH analoge to decrease fibroid size
What are some complications of fibroids?
Red degeneration
Progression to leiomyosarcoma <0.1%
Stone womb - calcification
Subfertility/infertility
what is red degeneration?
Sx?
Tx?
Fibroid becomes ischemic and necrotic as it has outgrown its blood supply
Low fever, RLQ/LLQ pain, N+V in Patient with HISTORY OF FIBROIDS
Tx = supportive, hospital admission
