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Menorrhagia (ancillary (bloods (FBC (Hb, iron studies), TFTs), pipelle…
Menorrhagia
ancillary
urine pregnancy test
bloods
FBC
Hb
iron studies
TFTs
pipelle biopsy
endometrial thickness >12mm
hyperplasia
#
pelvic USS
TVUS
dilation and curettage
hysteroscopy
gold standard for endometrial hyperplasia
definition
excessive menstrual bleeding, impacting on quality of life
more than 80ml menstrual loss (normal 20-80ml)
types
ovulatory
regular
associated with dysmeorrhoea and PMS
anovulatory
irregular
heavy and prolonged
common in
puberty
older than 35 years
PCOS
aetiology
systemic
platelet disorders
coagulation disorders
thyroid disorders
pelvic
uterus
fibroids
endometrial hyperplasia and polyps
carcinoma
cervix
endometrium
adenomyosis
ectopic glandular tissue found in muscle
incomplete miscarriage
dysfunctional uterine bleeding
clinical
history
menstrual
amount
cycle
regularity
length
duration
intermenstrual bleeding
age of menarche
LMP
exclude pregnancy
parity
symptoms of thyroid disease
fatigue
cold sensitivity
constipation
dry skin
unexplained weight gain
hair changes
symptoms of anaemia
associated symptoms
abdo pain
constitutional symptoms
examination
signs of anaemia
signs of hypothyroidism
obesity
hair loss
brittle nails
non-pitting oedema
goitre
androgenic sx
hirsuitism
acne
acanthosis niagricans
signs of liver disease
hepatomegaly
jaundice
ecchymoses
bimanual examination
adnexal masses
tender uterus
vaginal examination
cervical inspection
cervical smear
diagnosis
blood loss >80ml
clinical
treatment
medical
tranexamic acid
COC
cyclical oral progesterone
DMPA
Mirena
NSAIDs
prolonged excessive bleeding
interruption of bleeding >10days
medrocyprogesterone acetate (MAP)
10-30mg daily for 4/52
norethisterone (NET
5-10mg daily for 4/52
maintenance
MPA or NET
5-10mg day 5-25 of each calendar month (if anovulatory)
tranexamic acid
COC
surgical
endometrial resection or ablation
pregnancy contraindicated following
hysterectomy
gold standard
option of prophylatic salpingectomy
complications
surgery
ablation
infection
dysmenorrhoea
adhesions
uterine perforation
hysterectomy
haemorrhage
VTE
bladder rupture
damage to ureter
chronic pain
changes to bladder and sexual function
incidence
pathophysiology