From the Guidelines
Menometrorrhagia evaluation should begin with a thorough history and physical examination, followed by laboratory tests including complete blood count, pregnancy test, thyroid function tests, and coagulation studies, as recommended by the American College of Radiology 1. The initial assessment is crucial in identifying the underlying cause of menometrorrhagia, which can be due to structural or non-structural etiologies.
- Structural causes include endometrial polyps, adenomyosis, leiomyoma, malignancy, and endometrial hyperplasia, which can be diagnosed with imaging studies 1.
- Non-structural causes, such as coagulopathies, ovulatory dysfunction, and iatrogenic etiologies, require a thorough history and laboratory tests to identify 1. Transvaginal ultrasound is the first-line imaging study to assess endometrial thickness and identify structural abnormalities like fibroids or polyps 1.
- Endometrial biopsy is recommended for women over 35 or those with risk factors for endometrial cancer to rule out malignancy 1.
- Saline infusion sonography or hysteroscopy may be needed for better visualization of intrauterine pathology 1. Treatment depends on the underlying cause and may include hormonal options like combined oral contraceptives, levonorgestrel IUD, or tranexamic acid, as well as non-hormonal options like NSAIDs 1.
- Surgical interventions such as endometrial ablation, myomectomy, or hysterectomy may be considered for refractory cases or specific pathologies, with endometrial ablation being a minimally invasive technique for patients with uterine fibroids associated with heavy menstrual bleeding who are refractory or intolerant to medical therapy 1. The approach should be individualized based on the patient's age, desire for fertility, severity of bleeding, and underlying etiology, with the goal of controlling symptoms while addressing the root cause, as supported by the most recent guidelines from the American College of Radiology 1.
From the Research
Evaluation of Menometrorrhagia
Menometrorrhagia is a condition characterized by heavy and irregular menstrual bleeding. The evaluation of menometrorrhagia involves several steps, including:
- Exclusion of pregnancy as a cause of bleeding 2
- Clinical examination to provide an accurate diagnosis and identify complications such as anemia 2
- Pelvic ultrasound examination and endometrial biopsy to eliminate endometrial cancer 2, 3
Diagnostic Procedures
Diagnostic procedures for menometrorrhagia include:
- Pelvic examination to rule out any cervical disease 4
- Pelvic ultrasound, both abdominal and transvaginal, as a first-line procedure for etiological diagnosis 4
- Hysteroscopy or hysterosonography as a second-line procedure 4
- MRI is not recommended as a first-line procedure 4
Treatment Options
Treatment options for menometrorrhagia include:
- Symptomatic treatment with tranexamic acid, levonorgestrel intrauterine device, or non-steroidal anti-inflammatory drugs (NSAIDs) 2, 3, 5, 6
- Specific treatment of the cause, such as hysteroscopic resection of myoma or polyp, endometrectomy, or hysterectomy 2
- Medical treatments, including combined oral contraception, progestins, and levonorgestrel-releasing intrauterine system 5
- Selective Progesterone Receptor Modulators (SPRMs) as a new treatment option for excessive menstrual bleeding 5
Effectiveness of Treatments
The effectiveness of treatments for menometrorrhagia varies, with: