Overview

• Abnormal uterine bleeding in the absence of organic pathology → affects 10% of women.
  • Anovulatory (90%) → due to unopposed oestrogen stimulation.
  • Ovulatory (10%) → prolonged progesterone secretion causes irregular shredding.
• DDx of Menorrhagia → dysfunctional uterine bleeding, fibroids, endometriosis, pelvic inflammatory disease, IUD.

Making Diagnosis

Clinical Features

• Bleeding → menorrhagia, inter-menstrual bleeding, dysmenorrhoea.
• Symptoms of Anaemia → fatigue, SOB, chest pain.

Investigations

• Examination → speculum and bimanual.

• 1st Line → FBC (anaemia), TFTs (hypothyroid), clotting screen (coagulation disorders).

  • Hypothyroidism → may cause heavy periods.

• 2nd Line → TVUSS (PCOS, fibroids, malignancy).

  <aside> 💡 Initial → FBC. Then do a TVUSS.

  </aside>

• 3rd Line → outpatient hysteroscopy / laparoscopy +/- biopsy (endometriosis).

Management Plan

• When woman wants contraception ⇒
  • 1st Line → Mirena (Levonorgestrel) IUS.
    • Sfx → acne, breast tenderness, mood disturbance, headaches.
    • May cause constant light bleeding for 6 months.
  • 2nd → COCP.
  • 3rd → Cyclical oral progesteroens (norethisterone).
• When woman does not want contraception (ie. fertility required) ⇒
  • To treat bleeding (no associated pain present) → Tranexamic acid, 1g TDS.
  • If there is associated pain → Mefenamic acid (NSAID).
• Surgical (when medical management failed) → endometrial ablation and hysterectomy.