Menorrhagia

Question 1

‘Impractical definition’ of menorrhagia?

Answer 1

Menstrual blood loss more than 80mL per cycle.

Or if woman believes there is an increase in volume(i.e clots, fluid) and is impacting her life

Question 2

Causes of menorrhagia

Answer 2

Uterine fibroids
Adenomyosis
‘Endometriosis’ –> iffy
Malignancy - cervical cancer, endometrial cancer
Dysfunctional uterine bleeding (diagnosis of exclusion)
PID
Hypothyroidism
Drugs i.e warfarin
IUCD insertion
Coagulation disorders i.e vWD, Thrombophilia

Question 3

Investigation for menorrhagia

Answer 3

Exclude pregnancy –> pregnancy test

1. Clinical exam (bulky mass in fibroids)
2. FBC, haematinics if indicated (not ferritin)
3. Coagulation disorder screen (if HMB since start of periods, family history)
4. STI screen (swab)
5. TSH if clinically hypothyroid

If > 45 years with failed medical therapy (usually start Mx if suspect DUB):
TVUS (usually if persistent IMB)
Hysteroscopy + Endometrial biopsy if scan shows abnormalities

Question 4

Treatment for menorrhagia

Answer 4

Medical:
IUS (if not wanting pregnancy) [1st line]
Tranexamic acid if wanting to get pregnant [2nd line]
oral progestogens [3rd line]
COCP [4th line]

Surgical: (usually for growth pathology)

1) Endometrial ablation (last line for DUB)
2) For fibroids > 3cm and wanting to get pregnant –> Uterine artery embolisation/ myomectomy
3) For fibroids > 3cm and not wanting to get pregnant
- -> hysterectomy (definitive treatment)