Menorrhagia

1
Menorrhagia

• F.S. 42yr Female
• HPC
• Menorrhagia with clots
• Cycle 5/31
• Mild dysmenorrhoea
• O/E
• Non-bulky uterus
• Cervix nad

2
Heavy Cyclical Menstrual Blood Loss

• Symptoms Suggestive of Other Pathology
• Intermenstrual bleeding
• Postcoital Bleeding
• Dyspareunia
• Pelvic Pain
• Risk Factors for Endometrial Cancer
• Tamoxifen
• Unopposed Oestrogen Tx
• PCOS
• Obesity

Hx
Normal or Bulky Uterus lt10wks
Uterus gt10 weeks,Pelvic Mass,Tenderness

• Exam
• Abdo.
• Bi-manual VE
• Swab, /- smear

FBC Triple swab
Inv.
Consider Referral
Tx in 1ry Care
3

• F.S. 42yr Female
• HPC
• Menorrhagia with clots
• Cycle 5/31
• mild dysmenorrhea
• No I/M or Post-coital Bleeding
• No Dyspareunia,Pelvic Pain
• PMH
• Hypothyroidism on thyroxine
• Cervical smear -Ve
• O/E
• not obese
• Non-bulky uterus

4
Hb Nl Patient Does NOT want Tx
Hb Low or Patient Requests Tx
Reassurance
Patient does Not require Contraception
Patient requires Contraception
Tranexamic acid 1g tds /or Mefenamic acid 500mg
tds starting on the 1st day of period for
heaviest days of flow
Mirena Coil
Long-acting Progestogens
Combined OCP
No control flow after 3/12
No control flow after 3/12 or side effects
Add Mefenamic acid
No control flow after 6/12
No control flow after 3/12
referral
Referral
referral
5

• Inv.
• Hb nl
• TFTs nl
• Triple swab Ve
• Mx.
• 12/3/01 -tranexamic acid
• 25/4/01 unable to tolerate,still menorrhagia
• -Fbc
• -U.S. Pelvis
• -COCP Microgynon 30
• 26/4/01 anaemia
• -oral FeSO4
• 15/5/01 U.S. Nad
• menorrhagia
• -referral BWH for pipelle

• BWH pipelle nad Dx. Func. Uterine Bleeding
• 20/7/01 -talked about Dx. And Mirena
• -COCP Loestrin 30
• -Fbc
• 27/9/01 Hb 12
• Fe studies
• 5/10/01 FE studies nl
• -off oral FeSO4
• Reg check TFTs always nl or slightly low with
  dose change thyroxine
• 2/7/04 menorrhagia repeat protocol W/U Nad
  talked about Mirena
• 19/7/04 Mirena fitted d/w patient pros/cons
• No Further Consults re This Issue to-date