A history of heavy cyclical menstrual blood loss over several consecutive cycles without any intermenstrual or post coital bleeding, should be obtained.

Refer for ultrasound scan & if pelvic mass check CA125 (immunology brown tube)

• Irregular bleeding
• Sudden change in blood loss
• Intermenstrual bleeding
• Post-coital bleeding
• Dyspareunia
• Pelvic Pain
• Pre-menstrual pain

2. Risk factors for endometrial cancer

• Tamoxifen
• Unopposed oestrogen treatments
• Polycystic ovary syndrome
• Obesity

Add full blood count to initial examination

No need:

• To arrange a scan if exam is normal;
• To measure ferritin levels;
• For thyroid function tests unless signs and symptoms of thyroid disease;
• No other endocrine investigations are necessary in investigating menorrhagia;
• An endometrial biopsy is not required in the initial assessment.

Mefenamic acid 500mg tds or tranexamic acid 1 g tds starting on first day of period for days of heavy flow

Mefenamic acid 500mg tds or tranexamic acid 1 g tds starting on first day of period for days of heavy flow

Whilst oral luteal phase progesterons are ineffective in reducing menstrual blood loss, intrauterine progesterons are effective

Hysterectomy

Endometrial Ablation

Mirena for Heavy or Painful Periods