Obstetrics and Gynaecology  |  Menorrhagia Pathway - Refer to Gynae OPD




Obstetrics and Gynaecology

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).

History

Examination

Investigations

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.



Last updated : Friday, August 21, 2015
Next review date : Saturday, August 20,2016


Disclaimer: This site is intended to be flexible and frequently updated. While every effort has been made to ensure accuracy, all information should be verified.