MBBS Menstruation, puberty, menorrhagia and menstrual disorders revision notes

A 16 year old, who is normally fit and well, attends the GP complaining of heavy and painful periods. She is requesting treatment for these complaints. She denies being sexually active. What is the most appropriate management option for her?

Antwoord: NSAIDs - this girl is suffering from subjective menorrhagia and dysmenorrhoea. NSAIDs would help with both these. She does not need an IUS as she is not sexually active.

A 43 year old woman has suffered with heavy periods for many years and has tried many medical treatments without success. She is constantly flooding and at times cannot leave her house due to heavy bleeding. She has completed her family of five children and her last blood test showed a heamoglobin of 8.9g/dL. She feels that she cannot cope with the bleeding anymore, and her husband is asking for a treatment that an guarantee success. What is the best management option for her?

Antwoord: HYSTERECTOMY - this is the best option because, this is the only treatment that will ensure amenorrhoea and the patient has finished her family.

A 29 year old woman presents to the GP with troublesome heavy periods. The medical treatments that she has tried have made little difference. She is known to have large uterine intramural fibroids. You confirm that she currently is trying for more children. What is the most appropriate management option for her?

Antwoord: MYOMECTOMY - this will allow preservation of her fertility.

A 42 year old overweight smoker attends with heavy periods. A scan reveals a normal uterus. She would like a long term treatment with minimal side effects that would offer treatment for menorrhagia and provide contraception. She is unsure whether she would like more children. She is adamant that she does not want surgery, as she is terrified of the prospect. What is the most appropriate management option for her?

Antwoord: INTRAUTERINE or SYSTEMIC PROGESTERONE - this is the most appropriate for her as she does not want surgery. This will offer her both contraception and a reduction in bleeding. she can use a progesterone only pill or the Mirena coil (an intrauterine device impregnated with progesterone). Because of her risk factors (weight, age and smoking habits) she is not suitable for the combined oral contraception pill.

A 41 year old woman, who has completed her family, has suffered from extremely heavy periods for many years. No medical treatments have worked. She admits that she would not require open surgery or a general anaesthetic. What is the most appropriate management option for her?

Antwoord: UTERINE ARTERY EMBOLISATION - this is performed by radiologists. A catheter is inserted via the femoral artery and is fed up to the uterine artery, where a coil or a piece of foam is deposited to occlude the blood supply to the fibroid. This can cause the fibroid to shrink by 50%.