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Irregular Menstrual Bleeding

Definition:

Between three & five episodes with fewer than 3 bleeding-free intervals of length 14 days or more

Information to include in referral letter:

Symptoms

Effect on quality of life

Contraception, Smear history

Treatment tried

Referral:

Irregular bleeding in peri-menopausal women (>45y) -    Refer to DIRECT ACCESS HYSTEROSCOPY

Irregular bleeding in women <45y                              -              Refer to the MENSTRUAL DISORDERS CLINIC

PELVIC ULTRASOUND

Offer pelvic ultrasound for women with irregular bleeding if any of the following apply:

·         the uterus is palpable abdominally

·         the history or examination suggests a pelvic mass

·         examination is inconclusive or difficult, for example in women who are obese

·         significant dysmenorrhoea (period pain)

·         a bulky, tender uterus on examination that suggests adenomyosis

·         for women who decline hysteroscopy, consider a pelvic ultrasound, explaining the limitations of this technique for detecting intracavitary causes of HMB (pelvic USS can miss about 50%of treatable pathology)

INVESTIGATIONS

FBC

Chlamydia screening

Reference

NICE Guideline Jan 2007 Heavy Menstrual Bleeding

Faculty of Sexual and Reproductive Healthcare (FSRH). Management of Unscheduled Bleeding in Women Using Hormonal Contraception. London: Royal College of Obstetricians and Gynaecologists (RCOG); 2009.

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