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Heavy Menstrual bleeding in General Practice

Heavy Menstrual bleeding in General Practice. Kate Hooks. Aim. Common referral to the menorrhagia clinic Need to know- what it is - how to diagnose it - recognise red flags - treatments in gp -when to refer - . Definition.

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Heavy Menstrual bleeding in General Practice

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  1. Heavy Menstrual bleeding in General Practice Kate Hooks

  2. Aim • Common referral to the menorrhagia clinic • Need to know- what it is - how to diagnose it - recognise red flags - treatments in gp -when to refer • -

  3. Definition • Excessive heavy menstrual bleeding over several consecutive cycles, which interferes with the woman's physical, emotional, social and material QOL. (national collaborating centre for women's and children's health 2007)

  4. Background • 1/3 women describe their periods as heavy. • 40-60% no underlying abnormality. • Causes- Uterine and Ovarian - Systemic - Iatrogenic Complications- IDA

  5. History • Menstrual history • Gynaehx- red flags - pain - discharge - contraception/family plans - smear status Systemic disease Family history

  6. Examination • NICE- suggestion underlying problem - initial treatment ineffective - considering IUS

  7. Investigations • FBC • TFTs/Clotting if clinically indicated • Opportunistic cx screen if appropriate • TV USS -suggestion of underlying cause -palpable uterus -treatment ineffective - Pelvic mass- urgent ref

  8. Management • Advice and counselling on mens loss and options/ impact future family planning/ written info • Mirena IUS considered 1st line- provided LT contraception desirable- min 12 months • Tranexamic acid/ NSAIDS/ COC • Oral Norethisterone or long acting progestogens Norethisterone-5-26- not effective contraception Depot provera Switch Add Refer

  9. When to refer • RED flag symptoms- urgent -persistent IMB/PCB - unexplained vulval or vaginal lump - clinical features of cervical ca. • Heavy bleeding persists • Woman requests surgery • IDA persists despite treatment

  10. Secondary care • Investigations Endometrial biopsy- IMB/ >45/ treatments failed Hysteroscopy- USS inconclusive D+C no longer recommended as diagnostic tool.

  11. Drugs • GNRH analogues Before surgery Treatment for fibroids - Significant SE

  12. Surgical • Endometrial ablation 1st generation- loop diathermy 2nd generation- thermal balloon, radiowaves Good evidence NICE-impact QOL - drug methods failed/ not suitable - completed family - n uterus/ fibroids < 3cm • Hysterectomy • Uterine Artery embolisation/ myomectomy

  13. Questions??

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