- Refer to local Healthpathways or local guidelines
A woman with heavy menstrual bleeding is referred for early specialist review when there is a suspicion of malignancy or other significant pathology based on clinical assessment or ultrasound. Link: https://www.safetyandquality.gov.au/our-work/clinical-care-standards/heavy-menstrual-bleeding/
Consider increased risk of hyperplasia or malignancy if:
- Endometrial thickness greater than 12mm (transvaginal USS ideally day 4-7)
- Irregular endometrium or focal lesion
- Weight >90kg
- PCOS / diabetes / unopposed oestrogen
- Age >45yrs
- Intermenstrual or post-coital bleeding
Medical treatment prior to or while waiting for specialist review if no suspicion of malignancy:
- Progesterone releasing IUD
- Tranexamic acid
- OCP
- NSAIDS
- Oral progestogens
Referral is also arranged for a woman who has not responded after six months of medical treatment.