Managing Acute Menorrhagia

This week (after a very long break) we get back to business.  We’ll take you through the diagnosis, management and investigation of acute menorrhagia.

Vlozka0701

“Vlozka0701” by Pastorius – Own work. Licenced under CC BY 3.0 via Wikimedia Commons – https://commons.wikimedia.org/wiki/File:Vlozka0701.jpg#/media/File:Vlozka0701.jpg

Take Home Messages:

  • Acute Menorrhagia can be severe enough to create haemodynamic instability, assess for shock first.
  • Always perform a B-hCG to exclude pregnancy/miscarriage
  • Be sure to exclude a pelvic infection in your work-up
  • Consider inherited platelet dysfunction or coagulopathies in the adolescent with new menorrhagia
  • Consider endometrial hyperplasia or cancer in the woman over 35
  • Medical management may include NSAIDs, high-dose Progesterone, Tranexamic Acid
  • Surgical management may include Dilation & Curettage

References & Resources:

Adolescent Gynaecology – Menorrhagia Clinical Practice Guidelines, Royal Children’s Hospital Melbourne (Australia)

Menorrhagia (PDF) Australian Doctor Magazine ‘How To Treat’ (2009)

Heavy Menstrual Bleeding NICE Guideline UK (2007, updated 2013)

 

 


Perinatal Mental Health with Dr Matthew Coates

Today on the podcast we pick the brain of Dr Matthew Coates, a psychiatrist with experience in perinatal mental health. We talk about the common dilemmas of antidepressant prescribing in pregnancy and how to pick the post-natal patient with genuine mental illness as well as breastfeeding and neonatal issues. We also take a look at the more serious end of the spectrum of psychosis and mania in pregnancy and the post-partum period.

Take home messages:

  • Pre-conception planning is important for patients on psychotropic medications.
  • The ideal choice of antidepressants in pregnancy is the one that works for the patient. SSRIs have been better studied than SNRIs. Dosages may need to be increased in the third trimester.
  • Use non-drug strategies such as psychological therapies.
  • Patients with bipolar 1 and psychosis should be jointly managed with a psychiatrist.
  • Consider the effects of psychotropic medications on the neonate when planning for delivery.
  • Post-partum psychosis is a psychiatric emergency. Engage perinatal psychiatric services urgently.

By Mark Colomb (Flickr) [CC BY 2.0 (http://creativecommons.org/licenses/by/2.0)], via Wikimedia Commons

By Mark Colomb (Flickr) [CC BY 2.0 (http://creativecommons.org/licenses/by/2.0)%5D, via Wikimedia Commons

References & Resources

Massachuset’s General Hospital Center for Women’s Mental Health – womensmentalhealth.org

Perinatal Psychotropic Medications Information Service – ppmis.org.au

Drugs and lactation database – LactMed

Bergink et al, American Journal Of Psychiatry 2012 – Prevention of postpartum psychosis and mania in women at high risk