Menorrhagia Flashcards
What is the definition of menorrhagia?
A very heavy period
blood loss of over 80 ml or bleeding for more than 7 days
What are the causes for menorrhagia when the cycle is REGULAR and PAINLESS (5)
Fibroids Dysfunctional uterine bleeding Coagulation disorders Endometrial Carcinoma Endometrial Polyp
What is another name for uterine fibroids and what do they cause menorrhagia?
Leiomyoma
They increases the surface area of the endometrium and so increase the amount of blood loss
What is dysfunctional uterine bleeding?
often occurs in young girls
happens when there is a dip in oestrogen during the menses
this means there is a proliferation of the endometrium which causes more bleeding
What are the causes of menorrhagia when there is a REGULAR cycle and a PAINFUL period?
Pelvic inflammatory diseases
endometriosis
adenomyosis
intrauterine device
What are the causes of pelvic inflammatory disease?
infection
usually chlamydia or gonorrhoea
What is endometriosis and what is the most common symptom?
Implantation of endometrial tissue outside the uterus. Causes painful menorrhagia
In gynae what is adenomyosis?
endometrial tissue implanted the myometrium
What is the most common cause of a short cycle and excessive menses? what is this called?
It is called Epimenorrhagia and it can be due to ovarian dysfunction
What is the most common cause of amenorrhagia or olgigomenorrhagia in younger women?
Hypothyroidism
What is the most common cause of long cycle and excessive bleeding in gynaecology?
continuous use of the oral contraceptive pill
What investigations would you consider in menorrhagia? (5)
Bloods - FBC, clotting TFTs Swabs for infection pelvic ultrasound - fibroids polyps, endometrial thickening Endometrial sampling Hysteroscopy
What are the medical non-hormonal treatments which can be cinsidered in menorrhagia?
NSAIDs - mefanamic acid, naproxen, ibuprofen. These reduce bleeding and dysmenorrhoea by blocking COX-1 + 2
Anti-fibrolytics - tranexamic acid. these inhibit plasminogen activation which reduces clot formation
what are the hormonal treatments used in menorrhagia?
OCP in young
Marina coil in older and not considering children
Progesterone only or depotprovera
GnRH analogue - Goserelin. These inc GnRH which causes -ve feedback to oestrogen production
What are the surgical treatments for menorrhagia?
Endometrial ablation - only once family is complete
hysterectomy
Myomectomy in fibroids - maintains fertility
