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 of menorrhagia?
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 of menorrhagia
- 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 the investigations for menorrhagia?
- Pregnancy test
- FBC - haematinics, TSH
- Cervical smear if due
- STI screen
- Speculum examination - polyps
What are the ix for menorrhagia if >45 w RF or failed Rx
TVUS, endometrial biopsy and hysteroscopy and endometrial biopsy
What is the medical treatment of menorrhagia
- 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 for menorrhagia 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 of menorrhagia
- Endometrial ablation - destruction of the endometrium by microwave, thermal balloon or electrical impedance
- Uterine artery embolization - if wishing to retain fertility + fibroids
- Hysterectomy
