Menorrhagia

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History

A history of heavy cyclical menstrual blood loss over several consecutive cycles without any intermenstrual or post coital bleeding, should be obtained.

Examination: Uterus > 10 weeks in size, or pelvic mass tenderness

Refer for ultrasound scan & if pelvic mass check CA125 (immunology brown tube)

Examination: Symptoms suggestive of other pathology

1. Symptoms suggestive of other pathology

  • Irregular bleeding
  • Sudden change in blood loss
  • Intermenstrual bleeding
  • Post-coital bleeding
  • Dyspareunia
  • Pelvic Pain
  • Pre-menstrual pain

2. Risk factors for endometrial cancer

  • Tamoxifen
  • Unopposed oestrogen treatments
  • Polycystic ovary syndrome
  • Obesity
Investigations: Required

Add full blood count to initial examination

Investigations: Not required in initial evaluation

No need:

  • To arrange a scan if exam is normal;
  • To measure ferritin levels;
  • For thyroid function tests unless signs and symptoms of thyroid disease;
  • No other endocrine investigations are necessary in investigating menorrhagia;
  • An endometrial biopsy is not required in the initial assessment.
Mefenamic acid or tranexamic acid given

Mefenamic acid 500mg tds or tranexamic acid 1 g tds starting on first day of period for days of heavy flow

Mefenamic acid or tranexamic acid added

Mefenamic acid 500mg tds or tranexamic acid 1 g tds starting on first day of period for days of heavy flow

Note

Whilst oral luteal phase progesterons are ineffective in reducing menstrual blood loss, intrauterine progesterons are effective

Editorial Information

Last reviewed: 31 July 2016

Next review: 31 July 2018

Version: 2

Approved By: Due for review by high-uhb.tam@nhs.net

Reviewer Name(s): Lucy Caird