Management of heavy bleeding

Question 1

Mefenamic acid and NSAID - how effective are they?

Answer 1

Associated with a reduction in mean menstrual blood loss of 20 - 25 %

Question 2

When is Mefenamic acid and NSAID first line?

Answer 2

Tx of choice where heavy bleeding and dysmenorrhoea co exists

Question 3

When is Mefenamic acid and NSAIDs contraindicated?

Answer 3

1. Contraindicated with a history of
   - duodenal ulcer
   - asthma

Question 4

How effective is Tranexamic acid?

Answer 4

Associated with mean reduction in menstrual blood loss of 50%

Question 5

How is tranexamic acid taken?

Answer 5

• Only to be taken on days where bleeding is particularly heavy
• compatible with attempts of conception

Question 6

Combined contraceptive pill - how effective is it?

Answer 6

Very effective especially as it double sup as contraception if taken properly

Question 7

Contraindications of combined oral contraceptive pill

Answer 7

1. Patients with risk factors for thromboembolism
2. > 35 years and smoke
3. History of breast cancer
4. If overweight

Question 8

Norethisterone - how effective is it

Answer 8

cyclical progesterone taken from day 6 to 26 of menstrual cycle
- regulates bleeding pattern

Question 9

Disadvantages of prescribing Norethisterone

Answer 9

1. Not a contraceptive and can cause breakthrough bleeding

Question 10

Mirena coil - benefits

Answer 10

1. Contraceptive cover

2. Effective for dysmenorrhoea

Question 11

GnRH agonists - how do they work?

Answer 11

Act on the pituitary gland to stop the production of oestrogen

Question 12

Benefits of GnRH agonist use

Answer 12

Effective for associated dysmenorrhoea

Question 13

Disadvantages of GnRH agonists

Answer 13

1. Irregular bleeding
2. Menopausal symptoms - flushing and sweating
3. Only suitable short term unless combined with HRT

Question 14

Surgical management options

Answer 14

1. Endometrial ablation

2. Hysterectomy