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Menorrhagia (heavy menstrual bleeding) - Management
When and how should I examine the woman?
- Consider abdominal and pelvic examination in the following women:
- Women with symptoms suggestive of underlying abnormalities, before further investigations are arranged.
- Those in whom initial treatment has proved ineffective.
- Those for whom the levonorgestrel-releasing intrauterine system is being considered.
- A pelvic examination should include:
- Vulval examination for evidence of external bleeding and signs of infection (e.g. vaginal discharge).
- Speculum examination of vagina and cervix. High vaginal, endocervical, and chlamydia swabs should be obtained if infection is suspected.
- Bimanual palpation to identify uterine or adnexal enlargement or tenderness.
- In addition to abdominal and pelvic examination, look for systemic signs of underlying disease:
- Endocrine disease: hirsutism, striae, thyroid enlargement or nodularity, or changes in skin pigmentation.
- Coagulation disorders: bruises or petechiae.
- Women who refuse an examination should be referred directly for investigations as appropriate.
- Women who have fibroids that are palpable abdominally should be offered immediate referral or sent for an ultrasound.
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