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History:
How heavy? How often sanitary pad/tampon needs to be changed? Heavy for how many days?

Any symptoms of anaemia?Any intermenstrual bleeding to suggest endometrial pathology?


Pelvic Examination:
Pelvic mass, tenderness

Speculum exam: cervical lesions, pap smears


Investigation:
FBC, Fe studies, TFT, Coag
TVUS looking for:
Endometrial issues: hyperplasia
Intracavitory lesions: Polyps or fibroids
Wall lesions: fibroids, adenomyosis


Medical Therapy:
Tranexamic Acid (Cyklokapron)
Action: Antifibrinolytic
Dose: 500mg x 2 QID (100)
Indication: HMB (consider alternative if not effective after 3 cycles)
CI: History or risk of arterial or venous thromboembolic disease
Caution: concomitant use with COCP
SE: Nausea, vomiting, dizziness, Visual disturbance, seizure


NSAID (eg Ponstan Mefanamic Acid)
Action: Inhibits Prostaglandin synthesis

Dose: 250mg x2 TDS
Note: Not as effective as TA or Progestogen


Progestogen (Primolut N 5mg 30)
Action: Stablise endometrium, inhibits tPA, enhances vasoconstriction
To arrest acute HMB: 5mg tds x 10 day
Cyclically: 5mg daily day 5-25
Continuously: 5mg BD for 4-6 months
CI: History or risk of arterial or venous thromboembolic disease
SE: breast tenderness, acne, weight gain. bloating, moodiness, migraine


Combined Oral Contraceptive Pills(COCP)
Action: Stabilise lining of uterus, suppress cyclical hormone changes, prevent mid cycle oestrogen surge.
CI: thromboembolic risks: Obesity, Hypertension, smoking
Caution: Monitor fibroid growth
Note: No specific studies that OCP reduces HMB in fibroids or adenomyosis.


Progesterone-releasing IUD (Mirena)
Action: endometrial atrophy
Caution: Submucosal fibroid: bleeding due to friction, difficult to insert or expulsion.
SE: similar to oral progestogen; continuous spotting or bleeding.


References:
1.Medical management of heavy menstrualbleeding, Jacqueline A Maybin,, Hilary OD Critchley, Womens Health (2016) 12(1), 27–34
2. Available management options for heavy menstrual bleeding, Prescriber ,19 September 2014
https://wileymicrositebuilder.com/prescriber/wp-content/uploads/sites/23/2015/12/Available-management-options-for-heavy-menstrual-bleeding.pdf

Additional information for Referring Doctors by Dr Eisen Liang, Fibroid Embolisation Specialist, 

UFE Factsheet for referring doctors

UFE Patient Informtion Brochure

UFE FAQs from referring doctors

Australian Doctor : How to Treat Fibroids

Liang ANZJOG UFE Audit Paper 2012

Adenomyosis Review 2017

Links to reference materials

FACT SHEETS

View fact sheet for patients here

View fact sheet for GP here

View fact sheet for medical writers here

Disclaimer

Important information about the content and use of this website.Fibroid.com.au was established by Dr Eisen Liang to provide general information on fibroid treatmentsavailableespecially with UFE.The intent of this website is to inform, educate and provide general information to the general public about UFE as a surgical alternative to other treatment options.

Please DO NOT base the decision of your treatment choice on the information from this website alone.

To the extent that any information is provided through this websiteit is for general informational purposes only and is not intended to constitute or substitute for (i) medical advice or counseling, (ii) the practice of medicine including but not limited to psychiatry, psychology, psychotherapy or the provision of health care diagnosis or treatment, (iii) the creation of a physician-patient or clinical relationship, or (iv) an endorsement, a recommendation or a sponsorship of any third party, product or service by us or any of our related companies, agents, employees, consultants or service providers.

Using this website doesnot constitute nor substitute for medical advice by a qualified medical practitioner. Medical decisions should be made in consultation with a suitably qualified medical practitioner. If you have or suspect that you have a medical problem, contact your health care provider immediately.

As a recipient of information from this website, you are not establishing a doctor/patient relationship with Dr Eisen Liang.

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