Dysmenorrhoea and heavy menstrual bleeding

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Target exams

Red flags

• Heavy menstrual bleeding from menarche warrants a bleeding-disorder screen (von Willebrand disease, platelet function defect) — the most common presenting feature of a bleeding disorder in females
• Pain that breaks through NSAIDs and the combined oral contraceptive, is non-cyclic, or carries dyspareunia, dyschezia or GI/GU symptoms points to secondary dysmenorrhoea — most often endometriosis or an anatomic cause
• A sexually active adolescent with pelvic pain or bleeding is tested for pregnancy and sexually transmitted infection before the presentation is attributed to a benign menstrual cause
• Acute severe heavy menstrual bleeding with haemodynamic compromise needs intravenous access, fluids, a hormonal taper and tranexamic acid, and escalation to transfusion when indicated
• Progressive dysmenorrhoea with an enlarging pelvic mass in a menstruating adolescent raises an obstructive Müllerian anomaly with a haematocolpos — image and refer urgently

Life stages

Care settings

Clinical exam formats

Board mappings

• Dysmenorrhoea and heavy menstrual bleeding
• Long case: dysmenorrhoea and heavy menstrual bleeding in the adolescent
• Communication: adolescent menstrual health and confidentiality
• Dysmenorrhea and heavy menstrual bleeding in the adolescent
• Patient Care: dysmenorrhea and heavy menstrual bleeding in the adolescent
• Medical Expert: dysmenorrhea and heavy menstrual bleeding in the adolescent