Menorrhagia

Last updated 03.11.12

 

Index

 

Definition

-  >80mls per period (over entire duration)

 

Features

-  Difficult to determine exact volume

-  Increased flow in context of using same pads

 

Causes

-  Polyps

-  Fibroids

-  IUD (esp Copper)

-  Bleeding diathesis

-  Endometrial hyperplasia

-  PCOS

-  HRT (Oestrogen only)

-  Obesity

-  DM

-  HNPCC (Lynch syndrome)

 

Associated S/S

-  Vaginal bleeding

-  Clots

-  Increased flow

-  Number of pads not a sensitive indicator

 

Ix

-  Pelvic US

-  Endometrial thickness: <3mm postmenopausal, upto 20mm if menstruating

 

Mx

-  Endometrial hyperplasia

-  Simple 1% risk endometrial Ca

-  Progesterone

-  Complex 2-3% risk endometrial Ca

-  Hysterectomy

-  Progesterone

-  Atypical 23% risk endometrial Ca

-  Hysterectomy

-  Progesterone

-  Hysterectomy

-  Preferred option unless family not completed

-  Offer if atypical hyperplasia

-  Progesterone

-  Norethisterone 5mg PO TDS

-  Take 3 weeks out of 4

-  Then breakthrough bleed for 1 week

-  Drug of choice if endometrial hyperplasia

-  Tranexamic acid

-  Mefanamic acid (NSAID)

-  Esp if dysmenorrhoea

 

 

 

References