The important conditions to rule out first include pregnancy, endometrial hyperplasia (abnormal thickening of the lining of the womb) and endometrial carcinoma.
If there are organic causes of menorrhagia, such as fibroids or adenomyosis, treatment options can be offered based on your wishes and fertility concerns.
If there is suspected chronic endometritis (risk factors include recent childbirth or intrauterine procedure), this can often be treated with a course of antibiotics.
If you are found to be anaemic, iron supplementation is usually recommended.
The general considerations guiding the choice of initial treatment are:
In the absence of any structural or histological abnormalities, or fibroids more than 3 cm causing distortion of uterine cavity, the recommendations for treatment are:
This may be considered also if you are close to menopause and other treatments are not working or contraindicated.
The choice of treatment will depend on both the uterine size and the patient’s desire to retain her uterus.