menorrhagia

Early specialist review is appropriate when malignancy or significant pathology is suspected.

For our patient, age 48, obesity, diabetes and new irregular HMB mean that just perimenopause is not an adequate endpoint.

We can offer symptom relief while arranging appropriate imaging and specialist or endometrial assessment.

Her vasomotor symptoms can still be addressed, but unexplained bleeding must be investigated before starting systemic MHT.

Do not prescribe MHT and leave the patient uncertain about whether bleeding warrants review.

For our 48 year old, the uterus is intact and contraception remains relevant.

A 52 milligram LNG IUD could potentially address HMB, contraception and endometrial protection with systemic estrogen, but only after her abnormal bleeding and endometrial risk are appropriately assessed.

One of the most common counseling gaps is contraception.

So as you say, avoid contact sports, but also thinking about particularly in women, menorrhagia, because of course, this is something that affects women in a way that haemophilia doesn't.

um, because it's not X linked in the same way.

And so having things like the combined oral contraceptive pill or an intrauterine device to prevent menstrual bleeding, um, or thinking about, uh, iron replacement as well, like screening for iron deficiency, that kind of thing.

Those, that more holistic thinking about Von Willebrand should be done particularly because it affects women that bleed every month.

Okay.

Okay, so let's wrap it up there.

And then we'll do a separate podcast on vomitoveran disease in pregnancy because that's a hot exam topic that Path love.

So what are our three golden nuggets today, David? So firstly, don't forget the role of tranexamic acid and things like intrauterine devices to reduce menstrual bleeding.