UTERINE BLEEDING, ABNORMAL

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INTRODUCTION

Surgical procedures as dictated by the diagnosis.

Perform a transvaginal ultrasound and endometrial sampling in all women over 45 years of age.

Actively exclude organic causes, e.g. fibroids, for abnormal uterine bleeding.

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MEDICINE TREATMENT

Dysfunctional uterine bleeding implies that no organic cause is present.

ARREST OF ACUTE HAEMORRHAGE

For excessively heavy anovulatory dysfunctional bleeding:

Progestogen, e.g.:

  • Norethisterone, oral, 5 mg 4 hourly for 24–48 hours.

OR

  • Tranexamic acid, oral, 1g 6 hourly on days 1–4 of the cycle. Specialist initiated.

After bleeding has stopped, continue with:

  • Combined oral contraceptive, oral, 1 tablet 8 hourly for 7 days.
    • Follow with 1 tablet once daily for 3 months.

FOR RESTORING CYCLICITY

For women in the reproductive years:

  • Combined oral contraceptive, oral, 1 tablet daily for 6 months.

OR

As alternative to combined oral contraceptives:

Progesterone only:

  • Medroxyprogesterone acetate, oral, 30 mg daily from day 5 to day 26 of the cycle.
    • Use for 3–6 cycles.

OR

  • Norethisterone, oral, 15 mg daily from day 5 to day 26 of the cycle.
    • Use for 3–6 cycles.

For perimenopausal women, if uterus present, HRT:

  • Conjugated oestrogens, oral, 0.625 mg daily for 21 days with the addition of medroxyprogesterone acetate, oral 10 mg daily from day 11 to day 21. o Day 22– 28 no treatment.
    • Use for 3–6 cycles.

ADD

For dysmenorrhoea and abnormal bleeding:

  • Ibuprofen, oral, 400–800 mg 8 hourly for 2–3 days depending on severity of pain.
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