Menorrhagia (Complete)

Question 1

Define menorrhagia

Answer 1

Excessive menstrual bleeding that impairs a womans QoL

Question 2

What are causes of menorrhagia?

Answer 2

Idiopathic (50% of cases)

Question 3

List examples of local causes of menorrhagia (7)

Answer 3

Fibroids

Endometrial cancer

Endometriosis

Endometrial polyps

Adenomyosis (lining of the uterus grows into uterine wall)

Pelvic inflammatory disease

Copper coil intrauterine devices

Question 4

List examples of systemic causes of menorrhagia (5)

Answer 4

Bleeding disorders (e.g. von Willebrand)

Hypothyroidism

Liver and kidney disease

Obesity

Annovulatory cycles (more common at the extremes of a women’s reproductive life)

Question 5

What is the most common cause of menorrhagia?

Answer 5

Idiopathic

Question 6

Menorrhagia with no identifiable pathological cause is known as?

Answer 6

Dysfunctional uterine bleeding

Question 7

What investigations should be considered for women with menorrhagia?

Answer 7

Bedside:

Basic obs: Check haemodynamic status

Bloods/imaging:

FBC: Check for anaemia
Iron studies: Check for iron deficient anaemia
Clotting screen: Check for clotting disorders
TFT: Check for thyroid causes

Imaging:
Transvaginal ultrasound: Check for local causes of heavy bleeding

Question 8

How is menorrhagia managed?

Answer 8

Medicine:

Mefenamic acid (Would be used for dysmenorrhoea and menorrhagia)
Tranexamic acid
Hormonal contraception (e.g. COCP)

Surgical/Invasive:

Mirena coil

Endometrial ablation: Severe cases

Hysterectomy: Severe cases

Question 9

What management can be considered for patients with severe menorrhagia?

Answer 9

Hysterectomy

Endometrial abalation