Professional Documents
Culture Documents
Menstrual Bleeding
Women reporting with heavy menstrual bleeding
Prolonged
Irregular
cycles
No
Refer
specialist
Yes
Abnormal
exam
uterine size
> 12 wks
No
severe
< 80 g/l
Anaem
ic
No
Mild or
moderat
Treat
e
anaemia
(80115g/l)
Assess risk of
endometrial
hyperplasia
Bodyweight 90
kg
Age 45 years
Other risk factors
High risk*
Unexplained
heavy
menstrual
bleeding
Assess endometrium
Transvaginal
ultrasound (TVS) or
Endometrial biopsy
if endometrium
12 mm or if TVS not
available
Hyperplastic
endometrium or
carcinoma
Biopsy
* Referral to specialist could be
Offer medical
therapy
Normal
endometri
um
Levonorgestrel
intrauterine system
Tranexamic acid
Nonsteroidal anti
inflammatory
agents
Norethisterone
(long course)
Oc pill
Danazol
No
Evaluation
and
considerati
on for
surgery
Treatm
ent
success
Ye
s
Continue
medical
therapy