Irregular Menstrual Bleeding
Please refer to: Menstrual disorders clinic if <45
Hysteroscopy if >45
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 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.
Download Irregular Menstrual Bleeding PDF
Date Reviewed 26/08/2019
Date of Next Review 26/08/2020
Author Dr. Anna Harrold
Version No. 2.1