1. Case Study 3 - Menorrhagia
Presented by: Doug Barclay
Date: Monday 25th June

2. Learning Points Treatment options available
When to refer to a specialist
Pipelle vs ultrasound vs hysteroscopy
Mirena vs Novasure endometrial ablation
AUB – Auckland Regional Health Pathways

3. 10 minute consultation ?

4. 1st Appointment Hx Risk Assessment for Endometrial Pathology
Examination
Investigations
If no structural or histological abnormality suspected:
Start medical Rx

5. ? Structural Abnormality – TVUS
IMB / Polyp
Bulky Uterus /Fibroids

6. ? Histological Abnormality - Pipelle
HMB > 45 yo
IMB
PCOS
ET >12 mm
Risk of hyperplasia/ endometrial cancer in women with HMB:
All women 5%
>90kg 13%
>45 8%
PCB – cervical smears up to date? Refer to colposcopy

7. When to Refer? Failed 3 mth trial of medical treatment Severe anaemia
Severe impact on QOL
Fibroids / abnormal pelvic examination
Persistent IMB
Needs pipelle sampling

8. What about hysteroscopy?
Obtain histology / curettings
Remove polyps
Resect fibroids

9. 25 yo with regular heavy periods, normal BMI, normal examination and does not want hormones?

10. Medical Treatments

11. 30 yo with heavy periods after birth of second child?

12. Mirena IUS

13. 45 yo woman with major side effects from OCP in the past with heavy periods?

14. Novasure endometrial ablation

15. 40 yo woman, 2 previous C/S, slightly bulky fibroid uterus
40 yo woman, 2 previous C/S, slightly bulky fibroid uterus. Failed Novasure…..

16. Total Laparosopic Hysterectomy

17. Take Home HMB is common FBC +/- TVUS and pipelle
Increasing Mirena IUS and Novasure
Decreasing hysterectomies / Increasing TLH
Auckland Regional Health Pathway
Nice Guideline 88 / Phone App

20. NICE clinical guideline NG88, March 2018
Full guideline:

21. Thank you