Menorrhagia

Question 1

definition?

Answer 1

excessive menstrual bleeding (>80ml)

Question 2

aetiology?

Answer 2

• fibroids (most common)
• endometriosis
• adenomyosis
• dysfunctional uterine bleeding
• PCOS
• PID
• contraception ie copper coil
• endometrial hyperplasia / cancer
• endometrial polyp
• miscarriage
• endocrine - hypothyroidism, diabetes
• anticoagulants
• coagulopathy

Question 3

Ix?

Answer 3

• bimanual and speculum exam
• FBC
• B-HCG
• Pelvic USS
• Hysteroscopy if:
  
  • suspected endometrial pathology/ persistent IM bleeding

Additional tests:

• TFT, Ferritin, coagulation screen
• swab for infection

Question 4

Mx?

Answer 4

• Conservative
  
  • manage complications + any underlying cause
• Medical
  
  • Non-hormonal
    
    • tranexamic acid - no pain
    • mefenamic acid - pain
  • Hormonal
    
    • 1.IUS ie mirena coil
    • 2.COCP
    • 3.cyclical oral progestogens
• Surgical
  
  • endometrial ablation
  • Hysterectomy