Menorrhagia

Question 1

Definition

Answer 1

Excessive (heavy) menstrual blood loss, interfering with a woman’s physical, social, emotional, material quality of life

Question 2

Aetiology

Answer 2

• Heavy Menstrual Bleeding (HMB) - primary
  Secondary causes:
• Fibroids
• Endometrial polyps
• Endometriosis / adenomyosis
• Endometrial hyperplasia or cancer
• Pelvic inflammatory disease
• Contraceptive - copper coil

Question 3

Diagnosis

Answer 3

• Bloods
  = Full Blood Count (FBC) - anaemia
  = Clotting screen = vWf, other clotting disorders
  = Thyroid function = hypothyroidism
• Speculum and bimanual examination
• Pelvic and transvaginal US
• Hysteroscopy

Question 4

Treatment

Answer 4

No contraception
- Tranexamic acid when no associated pain (antifibrinolytic - reduces bleeding)
- Mefenamic acid when there is associated pain (NSAID - reduces bleeding and pain)
Contraception
- Mirena coil (first line)
- Combined oral contraceptive pill
- Cyclical oral progestogens, such as norethisterone 5mg three times daily from day 5 - 26