| Heavy Menstrual Bleeding (Menorrhagia) |
🩸 Excess endometrial proliferation due to unopposed oestrogen.
Coagulopathy, thyroid disease, or uterine pathology (fibroids, polyps) may contribute.
Defective vasoconstriction and fibrinolysis prolong bleeding.
|
- CBC – anaemia
- Coagulation profile
- Pelvic ultrasound (endometrium, fibroids)
- Thyroid function tests
- Consider endometrial biopsy ≥45 yrs or red-flag features
|
- Iron supplementation for anaemia
- Tranexamic acid or NSAIDs (first line per NICE)
- Levonorgestrel IUS (gold standard medical therapy)
- Oral contraceptives or cyclical progesterone
- Surgical: hysteroscopic resection, ablation, hysterectomy if refractory
|
| Painful Periods (Dysmenorrhoea) |
🔥 ↑ Prostaglandin F2α → uterine hypercontractility & vasoconstriction → ischaemic pain.
Secondary causes include endometriosis, adenomyosis, or fibroids.
|
- Pelvic exam
- Pelvic ultrasound (exclude secondary causes)
- Consider laparoscopy if severe, refractory pain
|
- NSAIDs (block prostaglandin synthesis)
- Hormonal therapy (OCP, LNG-IUS)
- Secondary dysmenorrhoea → treat underlying cause
|
| Amenorrhoea / Oligomenorrhoea |
⚖️ Dysfunction at any level of the HPO axis.
- Hypothalamic (stress, weight loss, excessive exercise)
- Pituitary (hyperprolactinaemia, adenoma)
- Ovarian (PCOS, premature ovarian insufficiency)
- End-organ (uterine scarring, e.g. Asherman’s).
|
- Pregnancy test (always first)
- Thyroid function, prolactin
- LH/FSH (low in hypothalamic; high in ovarian failure)
- Pelvic US (PCOS, structural lesions)
- Consider MRI pituitary if prolactin elevated
|
- Treat underlying cause (thyroid disease, pituitary adenoma, PCOS)
- Lifestyle modification (weight optimisation in PCOS)
- Hormonal therapy for cycle regulation / bone protection
- Refer to endocrinology/gynaecology if uncertain
|
| PMS / PMDD |
🌗 Cyclical symptoms in luteal phase.
Dysregulated serotonin pathways interact with fluctuating oestrogen/progesterone.
PMDD represents the severe end of the spectrum.
|
- Clinical diagnosis – prospective symptom diary
- Exclude thyroid dysfunction
|
- Lifestyle: regular exercise, diet optimisation
- SSRIs (first-line for PMDD)
- OCP to suppress ovulation
- Calcium, magnesium supplements (adjunctive)
|
| Polycystic Ovary Syndrome (PCOS) |
⚙️ Insulin resistance + ↑ LH/FSH ratio → ↑ ovarian androgen synthesis →
anovulation, cystic ovaries, hirsutism.
Long-term ↑ risk of T2DM, endometrial carcinoma.
|
- Pelvic US – “string of pearls” cysts
- LH/FSH ratio (↑ LH)
- Testosterone levels
- Glucose tolerance or fasting insulin
- Exclude other endocrinopathies (CAH, Cushing’s)
|
- Lifestyle: weight loss, exercise (restores ovulation in many)
- Metformin for insulin resistance
- OCP or cyclical progestogen for endometrial protection
- Clomiphene or letrozole if fertility desired
- Endocrinology or fertility referral if complex
|
| Endometriosis |
🌱 Ectopic endometrial tissue → cyclical bleeding outside uterus →
inflammation, scarring, adhesions.
Mediated by prostaglandins and cytokines; hallmark = chronic pelvic pain, infertility.
|
- Pelvic US (limited sensitivity)
- Laparoscopy – diagnostic & therapeutic gold standard
|
- NSAIDs for analgesia
- Hormonal suppression (OCP, progestins, GnRH agonists)
- Laparoscopic excision/ablation for severe disease
- Fertility counselling & specialist referral
|
