Menorrhagia

Question 1

What are the causes?

Answer 1

Idiopathic- dysfunctional uterine bleeding
Uterine pathology e.g. fibroids, polyps, endometriosis
Disorders of clotting
Hypothyroidism
PID
Anovulatory cycles- common at extremes of reproductive age

Question 2

What investigations should be done?

Answer 2

Bloods
- FBC
- Coagulation Screen
- TFTS
- HVS swab ?infection

If symptoms suggest underlying pathology
- Pelvic US ?fibroids
- ?Endometriosis- hysteroscopy
- ?adenomyosis TVUS

Question 3

When should someone with menorrhagia be referred under 2WW?

Answer 3

Pelvic mass with features of malignancy
Age >55 and post menopausal bleeding
Abnormal cervical examination
Ascites or abdo mass not due to fibroids

Question 4

What is the management?

Answer 4

Menorrhagia with no pathology, Fibroids <3cm, Adenomyosis
1) Mirena IUS
2) If IUS unsuitable then either TXA/Mefenamic acid or COCP or cyclical progesterone

If Fibroids >3cm
- refer to gynae for ?surgical management

Question 5

What are fibroids?

Answer 5

Benign smooth muscle tumours of myometrium

Question 6

What are symptoms of fibroids?

Answer 6

Menorrhagia
Pelvic pain
Dyspareunia
Urinary frequency/urgency
Constipation
SubfertilityW

Question 7

What is found on examination of fibroids?

Answer 7

Enlarged firm irregular uterus
Irregular abdominal mass

Question 8

What is a complication of fibroids?

Answer 8

Red degeneration of fibroids
-ischaemia and necrosis of fibroid
- occurs commonly during 2nd or 3rd trimester of pregnancy

Severe abdo pain
N&V, fever
will be in a pregnant woman with history of fibroids