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MENORRHAGIA - Coggle Diagram
MENORRHAGIA
Assessment
Onset e.g. peri-menarcheal, sudden, or gradual
Frequency/ Pattern, signs and symptoms of anaemia
Acute, chronic or Intermenstrual /Duration
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Menstrual history e.g. age of menarche, gravidity and parity
History of normal menstrual cycle or changes of pattern, last period
Past medical, drug and sexual history
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Investigation
Referral to outpatient hysteroscopy if history suggest submucosal fibroids, polyps or endometrial pathology
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Consider referral pelvic ultrasound for suspected large fibroids - palpable uterus, pelvic mass or inconclusive examination
Consider endometrial biopsy with hysteroscopy for higher risk of endometrial pathology - persistent / infrequent /heavy irregular bleeding, obese /PCOS, on tamoxifen
Suspected Adenomyosis - Offer transvaginal ultrasound to women with menorrhagia with significant dysmenorrhoea
Management
Refer - suspected cancer pathway within 2 weeks : pelvic mass, unexplained weight loss/bleeding, 55 years post menopausal bleeding, cervix appearance consistent with cancer
Urgent Gynaecology referral if ascites/pelvic /abdominal mass identified and history of high risk of fibroids, abnormality /adenomyosis
Refer to specialist if iron deficiency anaemia not responding to treatment and or menorrhagia not improved
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Treatment
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If menorrhagia and no identified pathology , fibroids < 3cm, adenomyosis - consider levonorgestrel intrauterine system first line treatment
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