Menorrhagia

Differential diagnosis

• Endometrial Ca – IMB, PCB, weight loss
• Ovarian Ca – weight loss, bowel habit changes, abdominal distension, early satiety, pelvic pain
• Infection – fever, PV discharge, change in partner
• Fibroids – bloating, pressure symptoms (bladder, bowel)
• Others – thyroid disease, coagulation disease, liver disease
• Dysfunctional uterine bleeding – if above ruled out

Data gathering

• Red flags – sudden onset, IMB, PCB, last smear
• Others – pads, clots, flooding, abdo pain, SOB/palpitations/lethargy, PV discharge, contraception, pregnancies
• Examine – abdomen, pelvis, speculum

Clinical management

• Investigations
  • Bloods – FBC, TFTs
  • Swabs – vaginal, endocervical
  • Cervical smear (if due)
  • USS Pelvis

• Explanation
  • many causes, changes in hormones, fibroids (benign growths), endometriosis (womb lining grows outside of the womb)

• Treatment
  • Menstrual diary
  • Medications
    • Tranexamic acid 1g TDS from day 1 of cycle for four days
    • Mefenamic acid 500mg TDS (if associated dysmenorrhoea)
    • Mirena coil
    • COCP / depot injection
    • Norethisterone 5mg TDS day 5 – 26

• Follow-up / Safety net
  • Consider referral if failed treatment or secondary anaemia.
  • Gynae can offer endometrial ablation, hysterectomy