1 / 13

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.

chipo
Download Presentation

Heavy Menstrual bleeding in General Practice

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  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??

More Related