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Menorrhagia is excessive (heavy) menstrual blood loss which occurs…
Menorrhagia is excessive (heavy) menstrual blood loss which occurs regularly (every 24 to 35 days) and interferes with a woman's physical, emotional, social, and material quality of life
Definition
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prevalence increases with age, peaks in women aged 30-49.
Defined as the need to change menstrual products every one to two hours, passage of clots greater than 2.54 cm, and/or 'very heavy' periods as reported by the woman.
Assessment
Investigations - FBC, TFTs, Hysteroscopy or ultrasound, vaginal or cervical swab, test for coagulation disorder
physical examination- abdominal examination, bimanual pelvic examination (not in young girls who are not sexually active)
detailed clinical assessment, and sexual history
Primary care Management
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For women with no identified pathology, fibroids less than 3 cm in diameter, or suspected or diagnosed adenomyosis:
Consider a levonorgestrel intrauterine system (LNG-IUS) as the first-line treatment
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Causes
Systemic disorders eg diabetes, hypothyroidism , liver or renal disease, coagulation disorders
Iatrogenic disorders e.g. anticoagulant drugs, herbal supplements, IUD, Chemotherapy
uterine and ovarian pathologies e.g. fibroids, endometriosis
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Secondary care options
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Drug Treatment: hormonal (ulipristal acetate, LNG-IUS, CHC, or cyclical oral progestogens) or non-hormonal (NSAIDs or tranexamic acid).
surgery - myomectomy, hysterectomy, endometrial abiation
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