Menorrhagia history

Question 1

Menorrhagia history

Answer 1

• Age
  
  • Heavy bleeding may be common in first year or menarche and perimenopausal years due to anovulatory cycles
• Number of pads per day
• Cycle regularity
  
  • Irregular cycle length and absent signs of ovulation breast tenderness, pelvic pain) may suggest anovulatory cycle
• Affect on everyday life

Differentials

Question 2

Aetiology of menorrhagia

Answer 2

Fibroids

• Pelvic pain/pressure
• Bowel/bladder pressure symptoms
• FHx of fibroids
  
  • Endometrial polyps
    
    • Spotting

Dysfunctional uterine bleeding

• No recognisable pelvic pathology (painless bleeding)
• Anovulatory cycles (↑ endometrial growth and hyperplasia due to unopposed oestrogen secretion)
• Associated with extremes of reproductive life

Pregnancy

• Miscarriage
  
  • Previous missed period
  • Recent intercourse
  • Pelvic pain

IUCD

Endocrine

• PCOS
  
  • Irregular cycle length
  • Hirsutism
  • Acne
  • Weight gain
• Hypothyroidism
  
  • Lethargy
  • Dry hair and skin
  • Weight gain
  • Cold intolerance
  • Constipation

Infection

• PID
  
  • Lower abdominal pain
  • Fever
  • Discharge
  • Hx of STD

Endometriosis

• Age 20-40
• Cramping pelvic/abdominal pain with menses
• Back/rectal pain
• Dyspareunia

Coagulopathy

• Excessive bruising
• Excessive bleeding (brushing teeth, surgery)

Anticoagulants

Endometrial/cervical cancer

• Weight loss
• Fatigue
• FHx