Menorrhagia Flashcards
Define menorrhagia
- Increased menstrual loss (>80mL/cycle)
- Based on female interruption to daily life
What are common causes of menorrhagia?
YOUNG
- Pregnancy (miscarriage)
- Dysfunctional uterine bleeding
OLDER
- IUCD
- FIbroids
- Endometriosis
- Pelvic infection
- Polyps
- Hypothyroidism
PERIMENOPAUSAL
Endometrial carcinoma
OTHER
-Clotting problems e.g. von willebrands/use warfarin
What investigations are conducted for menorrhagia?
BLOODS
FBC = anaemia
TFT = Hypothyroidism
Clotting factors = deficiency
IMAGING
US = pathology e.g. fibroids
w/ endometrial sampling if cancer suspected
SURGICAL
Laparoscopic
Hysteroscopy and directed biopsy
What are the red flags for endometrial cancer?
Persistent intermenstrual bleeding AND >45 yrs ALSO -Failed/ineffective treatment
What is dysfunctional uterine bleeding?
- Heavy/irregular bleeding in absence of pelvic pathology
- associated with anovulatory cycles in teenagers
- Genrally settles
- Diagnosis of exclusion
How is menorrhagia medically managed?
MIRENA (1st line)
ANTIFIBRONOLYTICS (1st line)
-Tranexamic acid
ANTIPROSTAGLANDINS (1st line)
-Mefenamic acid (taken during days of bleeding)
COMBINED PILL (2nd line)
Progestogens/norethisterone (3rd line)
What are the side effects and contraindications of tranexamic acid?
SIDE EFFECTS
- Leg cramps
- Minor GI upset
CONTRAINDICATIONS
-Thromboembolic disease
What are the side effects and contraindications of mefenamic acid?
SIDE EFFECTS
- GI upset
- Ulceration
- Renal impairment
CONTRAINDICATIONS
- Peptic ulcer
- Asthmatic
- CV disease
What are the surgical options for menorrhagia?
ENDOMETRIAL RESECTION
- If completed family
- <10wk size uterus
- fibroids <3cm
UTERINE ARTERY EMBOLISATION
-For women wishing to retain fertility >3cm
HYSTERECTOMY
- Women not wishing to retain fertility
- > 10wk size uterus
- fibroids >3cm
