Menorrhagia and Dysmenorrhoea Flashcards
What 2 investigations should be offered to women with menorrhagia?
FBC
Routine TV USS
What can be offered to women who require symptomatic management of menorrhagia in dysfunctional uterine bleeding but do not require contraception?
Mefenamic acid 500mg TDS
Tranexamic acid 1g TDS
Start on 1st day of period.
What can be offered to women who require symptomatic management of menorrhagia in dysfunctional uterine bleeding and also require contraception?
Mirena IUS
COCP
Long-acting progestogens (Depo-Provera)
What surgical options can be offered to women who have refractory dysfunctional uterine bleeding?
Endometrial ablation
Hysterectomy
A woman with fibroids is suffering menorrhagia.
Her fibroid is < 3cm.
What are the medical and surgical options for management?
Mefenamic acid, Tranexamic acid - symptoms
Mirena IUS
COCP
Cyclical oral progestogens (POP)
Ablation
Resection of submucosal fibroids
Hysterectomy
A woman with fibroids is suffering menorrhagia.
Her fibroid is > 3cm.
What are the medical and surgical options for management?
Mefenamic acid, Tranexamic acid - symptoms
Mirena IUS
COCP
Cyclical oral progestogens (POP)
GnRH analogues - reserved for pre-operative shrinking of fibroids
Uterine artery embolisation
Myomectomy - only surgery that increases fertility
Hysterectomy
A woman with adenomyosis has dysmenorrhoea, menorrhagia and dyspareunia.
What are the medical and surgical options for management?
Tranexamic acid
Mefenamic acid
Mirena IUS
COCP
Cyclical oral progestogens (POP)
GnRH analogues
Endometrial ablation
Uterine artery embolisation
Hysterectomy
A woman with adenomyosis has dysmenorrhoea, menorrhagia and dyspareunia.
What are the surgical options for management
Endometrial ablation
Uterine artery embolisation
Hyterectomy
A 13 year old girl presents with primary dysmenorrhoea.
What is the appropriate management?
Mefenamic acid
COCP 2nd line
How does primary dysmenorrhoea differ from secondary dysmenorrhoea?
Primary - onset 1-2 hours prior, begins at menarche
Secondary - onset 3-4 days prior, begins many years post-menarche
A woman presents with cyclical, deep pelvic pain and deep dyspareunia. You suspect endometriosis.
What is the gold-standard investigation?
Laparoscopy
A woman presents with cyclical, deep pelvic pain and deep dyspareunia.
Investigation reveals endometriosis.
What management may be offered in primary care?
NSAIDs/paracetamol
COCP/POP
A woman presents with cyclical, deep pelvic pain and deep dyspareunia.
Investigation reveals endometriosis.
Initial management has been ineffective.
What management may be offered in secondary care?
GnRH analogues - induces ‘pseudomenopause’
Surgical -
Excision and ablation of lesions
What contraceptive method may cause menorrhagia?
Copper IUD
A woman has chronic pelvic pain that worsens during menses. She also has post-coital bleeding and dyspareunia.
What is the likely diagnosis?
Chronic PID
