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Menorrhagia (heavy menstrual bleeding) - Management
What investigations can be carried out in secondary care?
- An endometrial biopsy for histological examination should be taken to exclude endometrial cancer or atypical hyperplasia, if appropriate, for example in women:
- With persistent intermenstrual bleeding.
- Aged 45 years and over.
- Whose treatment has failed or is ineffective.
- Hysteroscopy allows direct visualisation of the uterine cavity and the opportunity to take an endometrial biopsy. It is used as a diagnostic tool when ultrasound results are inconclusive, to determine the exact location of a fibroid or the exact nature of an abnormality.
- Dilatation and curettage (D and C) is no longer recommended as a diagnostic tool for heavy menstrual bleeding.
[National Collaborating Centre for Women's and Children's Health, 2007]
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