Sexual Health - Menorrhagia Flashcards
What is menorrhagia?
Women usually lose 40ml of blood during menstruation
Excessive is over 80mls
Volume rarely measured
How is menorrhagia diagnosed?
Based on symptoms
- Changing pads every 1-2 hours
- Bleeding lasting more than 7 days
- Passing large clots
What causes menorrhagia?
Dysfunctional uterine bleeding (no identifiable cause)
Extremes of reproductive age
Fibroids
Endometriosis
PID
Copper coil
Von Willebrand disease
Diabetes
Hypothyroidism
PCOS
What are key things to ask in a gynaecological problem?
Age of mencharge
Cycle length and variation
Intermenstrual bleeding and post-coital bleeding
Contraceptive history
Sexual history
Possibility of pregnancy
Plans for future pregnancy
Cervical screening
Migraines with or without aura
What investigations are done for menorrhagia?
Pelvic exam with a speculum and bimanual unless straightforward history
FBC to look for iron deficiency anaemia
When should outpatient hysteroscopy be arranged?
Suspected submucosal fibroids
Suspected endometrial pathology e.g. endometrial hyperplasia or cancer
Persistent intermenstrual bleeding
When should pelvic and transvaginal USS be arranged?
Possible large fibroids (palpable pelvic mass)
Possible adenomyosis
Examination difficult to interpret (obesity)
Hysteroscopy declined
What additional tests should be considered?
Swabs (infection)
Coagulation screen
Ferritin if anaemic
TFTs features of hypothyroidism
What treatment is given for symptomatic relief if contraception not wanted?
Tranexamic acid
When no associated pain, antifibrinolytic, reduces bleeding
Mefanamic acid
Associated pain, NSAID, reduced bleeding and pain
If contraception is wanted what is given?
Mirena coil (first line)
COCP
Cyclical oral progestogens
Secondary care referral if treatment unsuccessful
What are the final options when medical management has failed?
Endometrial ablation
Hysterectomy
