Adolescent Gynaecology - Menorrhagia
See also Adolescent Gynaecology - Lower Abdominal Pain
- Defined as >80mls blood loss / menstruation
- Equates to needing to change a super pad/tampon more frequently than every two hours
Assessment
- Menstrual history (last menstrual period, frequency, duration, flow, pain)
- FBE if recurrent/severe
- Clotting disorders are moderately common. Consider coagulation profile (PT, PTT, fibrinogen, von Willebrand screen) if recurrent/severe or associated with epistaxis/easy bruising or positive family history
- ßhCG if sexually active + delayed menses (possible threatened abortion or ectopic pregnancy)
Management
- Consult on-call Gynaecologist
Non-hormonal forms of treatment
- If anaemic or recurrent/severe bleeding: Iron supplements
- First line to decrease flow:
- NSAIDS (Naprogesic, Ponstan, Brufen) - also good if dysmenorrhea (anti-prostaglandin). Can decrease flow up to 30% if taken regularly every 4 – 6 hours during the first 48 hours of menstruation
- Cyklokapron (tranexamic acid, 1 gram, every 6 hours) can decrease flow 50% (is an antifibrinolytic)
Hormonal forms of treatment
- Progesterone (Norethisterone = Primolut, Medroxy-progesterone acetate = Provera). Good with anovulation (infrequent periods) due to the lack of progesterone
- Acute treatment: 5-10 mg x 21 days (N.B. Will bleed when ceased!)
- Prophylactic treatment: 7-10 days/month
- Combined oral contraceptive pill : can decrease flow by 50%. Good with anovulation/irregular menses
- Depo-Provera (75% amenorrhea after one year use)
- For acute severe bleeding: Premarin IV (25 mg IV every 4 hours) – will require admission
