EpistemisMenorrhagia
Specialty: Gynecology and breast.
Why it occurs
- Uterine fibroids (mainly submucosal or intramural with a submucosal component)
- Endometrial polyps
- Endometrial hyperplasia (with or without atypia)
- Ovulatory dysfunction (chronic anovulation in polycystic ovary syndrome or perimenopause)
- Underlying coagulopathies (Von Willebrand disease in adolescents)
- Copper intrauterine device (IUD)
Initial workup
Complete blood count with erythrocyte indices, iron kinetics (ferritin, transferrin saturation), complete coagulation profile (prothrombin time, aPTT, and specific Von Willebrand study if applicable). Transvaginal ultrasound with saline instillation (sonohysterography) or diagnostic hysteroscopy with directed endometrial biopsy to rule out hyperplasia or malignancy in those over 45 years of age or with risk factors.
red flags
Acute massive bleeding with hemodynamic instability (hypotension, tachycardia, dyspnea on exertion), constant passage of large clots (larger than a coin), need to change pads or tampons every 1-2 hours consecutively, symptomatic severe iron deficiency anemia (hemoglobin less than 8 g/dL).
Standard management
- Tranexamic acid 1000-1500 mg orally every 8 hours during heavy bleeding days — maximum 4 days per cycle
- Ibuprofen 400-600 mg orally every 8 hours during menstruation — reduces bleeding volume by altering endometrial prostaglandins
- Medroxyprogesterone acetate or micronized progesterone orally if there is underlying anovulation
- Placing a Levonorgestrel-releasing IUD (Mirena-IUD) as the most effective long-term preventive treatment (note: correct iron deficiency with ferrous sulfate 80-100 mg of elemental iron orally per day combined with vitamin C).
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Gynecology and breast
- Listed causes
- 6
- Treatment options
- 4