Obgyn: Menorrhagia: Free MSRA Podcast

⚕️ FREE MSRA PODCAST – Menorrhagia / Heavy Menstrual Bleeding🎧 In this high-yield episode, we unpack detailed revision notes on menorrhagia. From causes and clinical features to NICE-endorsed investigation and treatment pathways – we’ve got everything you need to know.🧠 Key Learning Points📌 Definition• Menorrhagia = excessive menstrual bleeding that impacts quality of life• No longer just defined by >80ml blood loss – subjective impact is key• NICE: bleeding that disrupts physical, emotional, social, or quality of life📌 Causes🔹 Dysfunctional Uterine Bleeding (DUB) – most common, esp. with anovulatory cycles in adolescence/perimenopause🔹 Uterine causes – fibroids, polyps, adenomyosis, endometritis, endometrial hyperplasia or cancer🔹 Systemic causes – hypothyroidism, bleeding disorders (e.g., von Willebrand disease), liver/kidney disease, obesity🔹 Iatrogenic causes – IUCD, anticoagulants, hormonal therapy💡 Mnemonic: PALM-COEIN(P) Polyps(A) Adenomyosis(L) Leiomyoma(M) Malignancy/hyperplasia(C) Coagulopathy(O) Ovulatory dysfunction(E) Endometrial causes(I) Iatrogenic(N) Not classified📌 Risk Factors• Age extremes – adolescence & perimenopause• Family history of menorrhagia• PCOS, endometriosis• Use of anticoagulants• Obesity, endocrine disorders📌 Pathophysiology• Hormonal imbalance, abnormal vessel fragility, or uterine abnormalities cause disrupted shedding and excessive endometrial bleeding📌 Clinical Features• Heavy menstrual bleeding requiring frequent pad/tampon changes• Use of both pad & tampon• Passage of large clots• Prolonged bleeding >7 days• Anaemia symptoms: fatigue, SOB, pallor• Impact on daily life is a diagnostic clue• Pain not always present – distinguish from dysmenorrhoea📌 Differential Diagnoses• Fibroids• Endometrial polyps• Endometriosis• Malignancy• DUB (diagnosis of exclusion)📌 Investigations🔹 Full Blood Count (FBC) – check for anaemia🔹 Thyroid Function Tests – if suspected🔹 PBAC (Pictorial Blood Loss Assessment Chart)🔹 TVUS (Transvaginal Ultrasound) – assess endometrial thickness, fibroids, polyps🔹 Endometrial Biopsy – >45 years, intermenstrual bleeding, failed treatment🔹 Outpatient Hysteroscopy – if pathology suspected🔹 Referral Indications: anaemia unresponsive to iron, suspected malignancy, abnormal pelvic findings📌 Management🩺 Medical (First-line)• NSAIDs (mefenamic acid) – reduce prostaglandins• Tranexamic acid – antifibrinolytic• Hormonal:LNG-IUS (e.g., Mirena) – first-line if contraception acceptableCOCP, long-acting progestinsNorethisterone (short-term control)🩻 Surgical (If medical fails / unsuitable)• Endometrial ablation – uterus <10-week size• Hysteroscopic myomectomy / UAE – for fibroids• Hysterectomy – last resort if fertility not desired⚠️ Hysterectomy NOT first-line for DUB💉 Give anti-D if Rh-negative and surgical management is used📌 Complications• Iron-deficiency anaemia• Reduced quality of life• Psychological distress• Potential fertility issues• Surgery risks – bleeding, infection, DVT, menopause if ovaries removed📌 Prognosis• Good with proper investigation & treatment• NICE: management should focus on improving QOL and aligning with patient preferences📎 More MSRA Resources📝 Revision Notes: https://www.passthemsra.com/topic/menorrhagia-heavy-menstrual-bleeding-revision-notes/🧠 Flashcards: https://www.passthemsra.com/topic/menorrhagia-heavy-menstrual-bleeding-flashcards/💬 Accordion Q&A: https://www.passthemsra.com/topic/menorrhagia-heavy-menstrual-bleeding-accordion-qa-notes/🚀 Rapid Quiz: https://www.passthemsra.com/topic/menorrhagia-heavy-menstrual-bleeding-rapid-quiz/🎓 Course: https://www.passthemsra.com/courses/obstetrics-and-gynaecology-for-the-msra/#MSRA #MSRARevision #MSRAMenorrhagia #MSRAFlashcards #MSRAQuiz #MSRAQANotes #MSRATextbook #ObstetricsAndGynaecology #HeavyMenstrualBleeding #GynaeMSRA #PALMCOEIN