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Menorrhagia (heavy menstrual bleeding) - Management
What should I ask about when taking the history?
The history should set out to define the nature of the bleeding; identify potential underlying causes; and to address the woman's ideas, concerns, expectations, and needs.
- Ask the woman her age at menarche and for details about her menstrual cycle — length of cycle, the number of days of menstruation, how long she considers her periods to be heavy, what were her periods like previously, and impact on quality of life.
- Enquire about symptoms that suggest an underlying pathology, particularly 'red flag' symptoms (e.g. persistent intermenstrual or postcoital bleeding).
- Consider the possibility of an underlying systemic disease, such as hypothyroidism or a coagulation disorder (e.g. von Willebrand disease).
- Take a family history, and in particular ask about endometriosis and coagulation disorders that may have a hereditary component.
- Check the woman's smear status.
- Ask about current contraceptive use, contraceptive plans, and future plans for a family.
- It is important to ascertain the woman's need for contraception, as this may impact on the choice of treatment. For more information, see Advice and counselling.
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