Case 1: Anaemia Secondary to Menorrhagia

• What symptoms of anaemia did this patient present with? What other symptoms of anaemia can you think of? The GP requested further blood tests for the patient – what blood tests do you think might have been included here?
• What cause of menorrhagia did this patient have? What other causes of menorrhagia can you think of? What treatment options for menorrhagia had this patient tried? What other options were discussed or are available?
• One treatment option mentioned was inducing menopause via an injection or hysterectomy. How did the patient react to this? What issues might need to be considered before/after doing this for this patient and other patients?
• What concerns did this patient raise about work? Consider both her concerns about being at work but also her concerns about not being at work. How did the patient and GP come to a shared decision about what would be appropriate for this patient’s work?
• What examination did the GP perform on this patient? What other examinations might have been useful for this presentation? Why might the BP cuff have not worked for this patient?
• What do you think was the main reason for this patient’s consultation? Bear in mind that she had an upcoming appointment with gynaecology for potential treatment. How did the GP manage the patient’s frustrations regarding the length of time things were taking?

Notes from Zero To Finals

Heavy menstrual bleeding is also called menorrhagia. On average, women lose 40 ml of blood during menstruation. Excessive menstrual blood loss involves more than an 80 ml loss. The volume of blood loss is rarely measured in practice. The diagnosis is based on symptoms, such as changing pads every 1 – 2 hours, bleeding lasting more than seven days and passing large clots. A diagnosis can be made based on a self-report of “very heavy periods”. Heavy menstrual periods can have a significant impact on quality of life.

Causes

• Dysfunctional uterine bleeding (no identifiable cause) - most common
• Extremes of reproductive age
• Fibroids - close second
• Endometriosis and adenomyosis
• Pelvic inflammatory disease (infection)
• Contraceptives, particularly the copper coil
• Anticoagulant medications
• Bleeding disorders (e.g. Von Willebrand disease)
• Endocrine disorders (diabetes and hypothyroidism)
• Connective tissue disorders