Menorrhagia

Question 1

what Ix should all women present with menorrhagia have

Answer 1

FBC - to rule out Fe def. anaemia

Question 2

Define Menorrhagia

Answer 2

Heavy menstrual bleeding: excessive menstrual blood loss interfering with quality of life

Question 3

PALM-COEIN

Causes of Menorrhagia

Answer 3

Structural causes:
Polyps
Adenomyosis
Leiomyomas (fibroids)
Malignancy and hyperplasia

Non-structural causes:
Coagulopathy (e.g. von Willebrand’s disease)
Ovulatory dysfunction (e.g. anovulation in PCOS)
Endometrial (e.g. endometriosis)
Iatrogenic (e.g. secondary to anticoagulant treatment)
Not otherwise classified (e.g. systemic causes such as hypothyroidism, liver or kidney disease)

Question 4

Menorrhagia Ix

Answer 4

1. Pelvic examination with a speculum and bimanual
2. FBC, Ferritin, TFTs, Coagulation screen
3. Pelvic + TVUS
4. HVS: abnormal discharge or suggestive sexual history

Question 5

Menorrhagia Mx without pathology OR fibroids <3cm

Answer 5

1st: levonorgestrel intrauterine system (LNG-IUS) - Mirena coil
2nd:Antifibrinolytic tranexamic acid OR NSAID Mefenamic acid for assoc pain
3rd: COCP, Cyclical Oral progestogen (norethisterone), Progesterone-only pill

Question 6

Menorrhagia Surgical Mx

Answer 6

1. Endometrial ablation: Microwave / Thermal balloon
2. Uterine artery embolization
3. Myomectomy
4. Hysterectomy

Question 7

4

Menorrhagia Sx

Answer 7

• Flooding
• Passage of clots
• Prolonged periods
• Fatigue and shortness of breath (if resulting anaemia)

Question 8

Define Dysfunctional Uterine Bleeding

Answer 8

HMB without any uterine, endocrine, haematological or infective pathology after investigation.

Dx of exclusion

Question 9

Menorrhagia Risk factors

Answer 9

• Age at menarche and approaching menopause
• Obesity