Heavy menstrual bleeding/Menorrhagia counselling

Question 1

reassure

Answer 1

1 in 3 women experience that

Question 2

establish what ‘heavy’ is

Answer 2

Flooding through to clothes or bedding.

Need frequent changes of sanitary towels or tampons.

Need double sanitary protection (tampons and towels).

Passing large blood clots

Effect on QoL

Question 3

causes

Answer 3

most unknown (dysfunctional uterine bleeding)
fibroids
endometriosis
hormonal problems
IUD
bleeding disorder, warfarin etc

Question 4

initial investigations

Answer 4

vaginal examination

speculum

FBC (anaemia)

keep menstrual diary - record number towels & tampons & days bleeding

swabs if infecttion // endometrial sampling

Question 5

cancer RFs

Answer 5

> 40 years
nulliparous
FHx
tamoxifen
IMB
post/coital bleeding
pain outside periods

Question 6

further investigations & why

Answer 6

USS –> hysteroscopy

rule out cancer
detect fibroids/polyps

Question 7

tx options

Answer 7

iron supplements

TXA - only bleeding, not pain. SE stomach upset

NSAIDs MNA/ibuprofen

if contraception wanted:
IUS - best

COCP

progesterone tablets, injection, implant

Surgery - ablation // hysterectomy