Managing Acute Menorrhagia

This week (after a very long break) we get back to business. We’ll take you through the diagnosis, management and investigation of acute menorrhagia.

Take Home Messages:

Acute Menorrhagia can be severe enough to create haemodynamic instability, assess for shock first.
Always perform a B-hCG to exclude pregnancy/miscarriage
Be sure to exclude a pelvic infection in your work-up
Consider inherited platelet dysfunction or coagulopathies in the adolescent with new menorrhagia
Consider endometrial hyperplasia or cancer in the woman over 35
Medical management may include NSAIDs, high-dose Progesterone, Tranexamic Acid
Surgical management may include Dilation & Curettage

References & Resources:

Adolescent Gynaecology – Menorrhagia Clinical Practice Guidelines, Royal Children’s Hospital Melbourne (Australia)

Menorrhagia (PDF) Australian Doctor Magazine ‘How To Treat’ (2009)

Heavy Menstrual Bleeding NICE Guideline UK (2007, updated 2013)