Obstetrics and Gynaecology | Menorrhagia Pathway - Refer to Gynae OPD
PATHWAYS
Menorrhagia Pathway - Refer to Gynae OPD
Please ensure your referral includes all the following whether negative or positive. This will ensure that that the patient is correctly prioritised by secondary care and allow more clinic time to discuss treatment options (an ereferral is being developed which will assist you with the referral process).
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History |
Examination |
Investigations |
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Bleeding history-clots / flooding / cycle length Associated PCB/IMB Dysmenorrhoea Dyspareunia Gravida/Parity Fertility desired? Medications - past Tamoxifen or unopposed oestrogen use Current contraceptive Smoking history Family history of endometrial or bowel cancer Known PCOS Psychological impact History of bleeding disorder |
Abdominal examination Pelvic examination Speculum examination - view the cervix and take smear if due or if concern Weight |
Pregnancy test Full blood count Ferritin Consider TSH (use clinical judgement) Consider coagulation screen (3-5% of menorrhagia patients have a coagulation disorder) Take swabs if considered clinically necessary or if a Mirena is to be considered Cervical smear if due/considered necessary Primary care referral for USS may be requested only if there is a palpable mass (>12/40 size uterus). For other cases the USS will either be carried out by the gynaecologist at the OP appointment, or in selected cases the gynaecologist will refer the patient to radiology. Note female hormone testing is not routinely required |
If pharmaceutical treatment is required while a clinic appointment is being arranged either Tranexamic acid, a NSAID drug or a progestorone can be used. AVOID oestrogen containing preparations until pathology is ruled out.
Next review date : Saturday, August 20,2016
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