menorrhagia

Question 1

what is menorrhagia?

Answer 1

an amount that the woman considers to be excessive

Question 2

what does the management of menorrhagia depend on?

Answer 2

whether woman needs contraception or not

Question 3

how do you investigate menorrhagia?

Answer 3

1. FBC - check for anaemia
2. transvaginal ultrasound scan if sx* or abnormal pelvic exam findings

*e.g. IMB, PCB, pelvic pain+/- pressure sx → suggests structural/histological abnormality

Question 4

what would you give a woman with menorrhagia who does not require contraception?

Answer 4

tranexamic acid 1st line

or NSAIDs, mefenamic acid (if there is dysmenorrhoea as well)

both started on 1st day of period

Question 5

what would you give a woman with menorrhagia who does require contraception?

Answer 5

1. intrauterine system (Mirena) 1st line
2. COCP
3. long-acting progestogens (e.g. Depo-Provera)

Question 6

what can be used short-term to rapidly stop heavy menstrual bleeding?

Answer 6

norethisterone