Case Study 3 - Menorrhagia

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Presentation transcript:

Case Study 3 - Menorrhagia Presented by: Doug Barclay Date: Monday 25th June

Learning Points Treatment options available When to refer to a specialist Pipelle vs ultrasound vs hysteroscopy Mirena vs Novasure endometrial ablation AUB – Auckland Regional Health Pathways

10 minute consultation ? https://www.bmj.com/content/bmj/321/7266/935.full.pdf

1st Appointment Hx Risk Assessment for Endometrial Pathology Examination Investigations If no structural or histological abnormality suspected: Start medical Rx

? Structural Abnormality – TVUS IMB / Polyp Bulky Uterus /Fibroids

? Histological Abnormality - Pipelle HMB > 45 yo IMB PCOS ET >12 mm Risk of hyperplasia/ endometrial cancer in women with HMB: All women 5% >90kg 13% >45 8% PCB – cervical smears up to date? Refer to colposcopy

When to Refer? Failed 3 mth trial of medical treatment Severe anaemia Severe impact on QOL Fibroids / abnormal pelvic examination Persistent IMB Needs pipelle sampling

What about hysteroscopy? Obtain histology / curettings Remove polyps Resect fibroids

25 yo with regular heavy periods, normal BMI, normal examination and does not want hormones?

Medical Treatments

30 yo with heavy periods after birth of second child?

Mirena IUS

45 yo woman with major side effects from OCP in the past with heavy periods?

Novasure endometrial ablation

40 yo woman, 2 previous C/S, slightly bulky fibroid uterus 40 yo woman, 2 previous C/S, slightly bulky fibroid uterus. Failed Novasure…..

Total Laparosopic Hysterectomy

Take Home HMB is common FBC +/- TVUS and pipelle Increasing Mirena IUS and Novasure Decreasing hysterectomies / Increasing TLH Auckland Regional Health Pathway Nice Guideline 88 / Phone App

NICE clinical guideline NG88, March 2018 Full guideline: https://www.nice.org.uk/guidance/ng88

Thank you