Menorrhagia

During consultation, your doctor will ask questions and perform an examination to try to determine the cause of the heavy menstrual bleeding.

Important information that you may provide to the doctor during the consultation include:

1. Other associated menstrual problems – pre-menstrual syndrome, inter-menstrual bleeding, post-coital bleeding, dyspareunia and pelvic pain
2. Fertility wishes
3. Whether you have symptoms of anaemia
4. Effect on your quality of life, including any time off work
5. Past medical problems, including clotting disorders, thyroid status and gynaecological history
6. Easy bruisability or bleeding gums
7. Your recent PAP smear, gynaecology history
8. Any family history of cancer

Clinical examination will be undertaken to assess for any anaemia and also to rule out potential organic causes of menorrhagia. This usually includes a pelvic examination.

Tests that may be carried out include:

• Urine pregnancy test to rule out pregnancy
• It is a good opportunity to have a PAP smear undertaken if not done recently
• Ultrasound (ideally trans-vaginal) is the first-line diagnostic tool for identifying abnormalities such as fibroids and polyps. The thickness of the lining of the womb can be seen on ultrasound.
• Endometrial sampling may be offered to test the cells in the lining of the womb, especially if there is a risk of cancer (determined by the above). This may be done in the clinic, or as a day surgery procedure called dilatation and curettage combined with the use of a small telescope to look at the inside of the womb, known as hysteroscopy. This procedure will also need to be considered in women who have not responded to medical treatment for menorrhagia.

A full blood picture will give an estimation of the degree of anaemia (low blood count). Other blood tests such as thyroid function tests and bleeding disorder testing may be performed if your doctor suspects a disorder.