Abnormal uterine bleeding is one of the common but under-reported conditions can be divided into four categories:
- Polymenorrhea – menstrual cycle less than 21 days
- Oligomenorrhea – menstrual cycle greater than 35 days
- Menorrhagia – increase in amount of menstrual bleeding.
- Metrorrhagia – change in amount and frequency of bleeding
Medications:
For Polymenorrhea
Tab. Ovral L (Ethinyl estradiol 0.03 mg, Levonorgestrel 0.15 mg) – 1 tablet a day.
- If last menses (LMP) within last 5 days or ff last menses more than 5 days back with no unprotected intercourse since LMP – start tab. Ovral L straight away for 21 days.
- With unprotected intercourse was within last 5 days – counsel, offer emergency contraceptive and carry out urine pregnancy test i-can pregnancy test kit. If patient is not pregnant, start tab. Ovral L for 21 days.
- If last unprotected intercourse was more than 5 days back – do urine pregnancy test and if negative, start tab. Ovral L for 21 days.
Tab. Trenaxa (Tranexamic acid 1000 mg) – one tablet thrice a day for a maximum of 5 days.
For oligomenorrhea
- Tab. Deviry (Medroxyprogesterone 10 mg) – one tablet for 10 days beginning on the 16th day of the cycle.
Supplementary treatments:
- Cap. R B Tone (Elemental iron 30 mg, Folic acid, Vit B12, Zinc) 1 capsule a day, two hours after lunch AND
- Tab. Limcee (Vitamin C 500 mg) 1 tablet once a day (two hours after lunch).
Investigations:
- Urine pregnancy test – to rule out pregnancy
- TSH – to rule out abnormal thyroid function tests
- Serum Prolactin – to rule out hyperprolactinaemia
- Complete blood count – to rule out anaemia and treat accordingly.
- Glucose to insulin ratio – abnormal results are suggestive of PCOD.
- HbA1c – to rule out diabetes
- USG Abdomen and pelvis – to rule out fibroid, endometrial thickening or other endometrial pathologies.
Referral:
Consider referral to gynaecologist in case of complications or if patient fails to respond to the above treatments.