bmjlearning.com: Menorrhagia

BMJ Learning offers interactive online learning resources to help you with your appraisal and revalidation. We aim to publish new modules every month, and we have recently published a module about diagnosing and treating menorrhagia. Menorrhagia is an important part of a general practitioner's workload, accounting for 1 in 20 consultations in the United Kingdom. Objectively, it is defined as a menstrual blood loss of at least 80 ml per menstruation, but there is no simple primary care tool for objectively measuring blood loss. About 60% of women who say they have heavy periods are found to have normal periods when their blood loss is measured. Taking a detailed history can help prevent women with normal periods from having unnecessary treatments, including hysterectomy. Most women with menorrhagia can be successfully treated in primary care if you prescribe the most effective drugs. Unfortunately, there is no good evidence of effectiveness for many commonly used treatments for menorrhagia. For example, oral progestogens are one of the most commonly prescribed treatments and yet are one of the least effective. They may even increase blood loss. Tranexamic acid and non-steroidal anti-inflammatory drugs are the treatments that work best. Surgery is an option for the minority of women who get little benefit from medical treatment. Hysterectomy and endometrial destruction are both associated with high rates of satisfaction in the long term. Women who have endometrial destruction are more likely to need repeat surgery, but the benefits of this technique include shorter duration of surgery, shorter hospital stay, and quicker time to return to work compared with hysterectomy. Myomectomy and dilatation and curettage are not helpful treatments for menorrhagia. To find out more about the diagnosis and treatment of menorrhagia, try our new learning module on bmjlearning.com