Menorrhagia

Question 1

What is menorrhagia

Answer 1

Heavy menstrual bleeding. More than 80ml lost (40ml normal)

Question 2

Causes of menorrhagia

Answer 2

Dysfunctional uterine bleeding (most common), Fibroids, Endometriosis, Pelvic inflammatory disease, contraception, anticoagulant meds, bleeding disorders, PCOS, endometrial hyperplasia

Question 3

Menorrhagia investigations

Answer 3

Pelvic examination - speculum and bimanual.
Full blood count to check for iron deficiency anaemia.
Arrange outpatient hysteroscopy and potentially pelvic and transvaginal ultrasound if suspected fibroids or endometrial pathology.
Infection? - swabs

Question 4

Menorrhagia initial management

Answer 4

Tranexamic acid (antifibrinolytic) when no associated pain.
Mefanamic acid (NSAID and also reduces bleeding) when there is associated pain.
When contraception management applicable:
1. Mirena coil (IUS)
2. COCP
May also use POP, injectino or implant

Question 5

Menorrhagia further management

Answer 5

Endometrial ablation (destroy endometrium) / hysterectomy 
Fill endometrial cavity with high-temp fluid that burns lining - balloon thermal ablation