Menorrhagia Flashcards
What is menorrhagia?
XS bleeding that interferes w the woman’s physical, emotional, social and material QOL
What is the objective definition of menorrhagia
blood loss of >80ml in an otherwise normal menstrual cycle
What is the most common cause
dysfunctional uterine bleeding - heavy and/or regular bleeding in the absence of recognisable pelvic pathology - a diagnosis of EXCLUSION
What are the other causes of menorrhagia attributable to increased age
- IUCD
- Fibroids
- Endometriosis
- Adenomyosis
- Pelvic infection
- Polyps
- Hypothyroidism
- Coagulation disorders
- If >45 yrs - endometrial carcinoma
What are the clinical features
- Heavy prolonged vaginal bleeding
- Dysmenorrhoea
- Sx of anaemia
- Pallor
- Abnormal - IMB + PCB so require Ix
- Check smear hx
- Enlarged uterus - suggests fibroids, adenomyosis
What are th ix
- Pregnancy test
- FBC - haematinics, TSH
- Cervical smear if due
- STI screen
- Speculum examination - polyps
What are the ix if >45 w RF or failed Rx
TVUS, endometrial biopsy and hysteroscopy and endometrial biopsy
What is the medical treatment
- Mirena - 1st line
This releases levonorgestrel into endometrial cavity leading to atrophy - Antifibrinolytics - tranexamic acid
Take during bleeding - NSAIDs - Methanamic acid
Taken during days of bleeding, esp. help w dysmenorrhoea - COCP
What is best medical treatment if trying to conceive
tranexamic acid
What are the CI of antifibrinolytics
thromboembolic disease
What are SE of IUD
Irregular bleeding. for 1st 4-6m
What are the surgical options for rx
- Endometrial ablation - destruction of the endometrium by microwave, thermal balloon or electrical impedance
- Uterine artery embolization - if wishing to retain fertility + fibroids
- Hysterectomy
