7 September 2018

Take 10: Medical management of menstrual bleeding

Clinical Women

What is the workup before referral for heavy menstrual bleeding?

“It is really important to take an excellent, comprehensive history,” Associate Professor Deborah Bateson, the Medical Director at Family Planning New South Wales, says.

GPs can ask questions such as: Is the patient using a medication that might increase heavy menstrual bleeding such as warfarin?; Does she have symptoms of, for instance, hypothyroidism or a bleeding disorder?; Is she at risk of STIs?; and What contraception is she using? Is she at risk of pregnancy?

“Then, of course, it’s the detailed menstrual history,” says Associate Professor Bateson.

“Her last period, how often the periods come, how long are they? Is there inter-menstrual bleeding, post-coital bleeding?

It’s also important to understand the patient’s use of sanitary protection, she says.

“Is she having to change her sanitary pads or tampons more frequently than every two hours?

“Is she using double protection at night? Is she having flooding and clots? These are all signs of heavy menstrual bleeding.”

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4 months 10 days ago

In 40+ women with heavy bleeding, if transvaginal ultrasound is normal and thickness is 5mm plus, should we still send her for endometrial sampling to exclude malignancy