Menorrhagia Flashcards
What is menorrhagia?
Heavy menstrual bleeding that interferes with QOL
(>80ml per cycle)
- Change in volume (clots, floods)
What are causes of menorrhagia?
Mostly due to dysfunctional uterine feeding Intrauterine contraceptive device Fibroids Endometriosis Adenomyosis (inner lining of uterus breaks through muscular wall) Pelvic infection Polyps Hypothyroidism Coagulation disorders Cancer
What is dysfunctional uterine bleeding?
Heavy and/or irregular bleeding in the absence of recognisable pelvic pathology
Exclusion diagnosis
What should you consider in menorrhagia in women > 45 years
Endometrial carcinoma
What are symptoms and signs of menorrhagia?
Heave prolonged vaginal bleeding Often worse at extremes of reproductive life Dysmenorrhoea Symptoms of anaemia Pallor
IF IMB, PCB, investigate and check smear history
What does an enlarged uterus suggest?
Fibroids
Adenomyosis
Cervical polyp
What investigations in menorrhagia?
Pregnancy test FBC TSH Cervical smear if due STI screen
IF >45 years and risk factors or failed medical therapy
TVUS - fibroids, polyps, endometrial thickness
Endometrial biopsy
Out-patient hysteroscopy + biopsy of endometrium
What is first line treatment for menorrhagia? How does this work?
Mirena intra-uterine system
Reduces bleeding by releasing levonorgestrel into the endometrial cavity leading to atrophy
What are side-effects of Mirena IUS?
Irregular bleeding for 1st 4-6 months Progestogenic effects: Weight gain Fluid retention Acne N/V
What other medication can be taken during bleeding?
Antifibrinolytics: tranexamic acid - reduce blood loss (for up to 4 days while bleeding)
Useful in those trying to conceive as it is non-hormonal
NSAIDs (mefenamic acid) during bleeding to help if there is also dysmenorrhoea
GnRH can be used to temporarily induce menopausal state
What are CI of antifibrinolytics?
Thromboembolic disease
When is surgery indicated for menorrhagia?
Women who do not respond to medical mx
Fibroids > 3 cm
What surgical techniques for menorrhagia? How does this work?
Endometrial ablation
Destruction of the endometrium by microwave, thermal balloon or electrical impedance
Contraception is still required
Uterine artery embolisation for women wishing to retain fertility who have fibroids > 3cm
Hysterectomy for women not wishing to retain fertility with fibroids > 3cm - vaginal is preferred
