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Polymenorrhea – Information for GPs

Definition

Frequent bleeding with shorting of menstrual cycle (eg < K- 5/21) for more than 3 cycles

Red flag symptoms

  • Persistent Intermenstrual bleeding (IMB) if >45 or other risk factors for endometrial cancer (eg obesity, PCOS unopposed estrogen, tamoxifen)
  • Age over 45 is a relative indication for early referral

Management

Under age 45

Consider hormonal profile: TFTs, FBC

Offer hormonal therapy (any of):

  1. COCP 3m minimum
  2. Cyclical Norethisterone/ Provera days 5-24, for three cycles
  3. Depo Provera
  4. Mirena- at least 6m trial

If enlarged uterus on examination: Routine USS, if normal- under 14w size- consider Mirena

Investigations prior to referral

  • Chlamydia screening
  • High Vaginal Swab
  • Pelvic USS
  • Nb DON’T perform a cervical smear if outside the screening programme

Information to include in referral letter

  • Describe problem (cycle, quantity e.g. pad usage, duration) and effect of quality of life
  • FBC and USS results
  • Current contraception
  • Smear history (including last smear & result) the patient will still be seen without this but if you can retrieve it automatically it speeds up the appointment
  • Treatment options please include which tried and whether effective

Desirable information

  • Indication of parity
  • Expectations of referral
  • Exclusions of pathology & reassurance
  • Endometrial ablation/TCRE
  • Hysterectomy

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