Menstrual Disorders & Abnormal Bleeding
Assess abnormal bleeding, anaemia and structural or hormonal causes using a patient-centred plan.
Quick revision ↓ Medical Dictionary
01Describe the problem
Ask about cycle frequency, regularity, duration, heaviness and bleeding between periods or after intercourse. Assess pain, impact on daily life, pregnancy possibility and medicines, including anticoagulants. Heavy bleeding with instability needs urgent care. The patient’s functional burden matters; exact measurement of menstrual volume is not required before offering assessment and support.
02Organise the differential
Structural causes include polyps, adenomyosis, fibroids and malignancy or hyperplasia. Non-structural causes include coagulation disorders, ovulatory dysfunction, endometrial factors and treatment-related bleeding. Several causes may coexist. Consider pregnancy-related bleeding where possible, and avoid assuming that a known fibroid explains every new symptom without a suitable reassessment.
03Investigations
A blood count helps identify anaemia in heavy menstrual bleeding. Examination and imaging or hysteroscopy depend on symptoms and suspected pathology. Persistent intermenstrual bleeding, risk factors or treatment failure may warrant endometrial assessment through the appropriate pathway. Screening tests do not replace investigation of symptoms, and a normal cervical screening history cannot explain uterine bleeding.
04Treatment choices
Discuss medical and procedural options according to the cause, severity, contraindications and future fertility wishes. Suitable options can include a levonorgestrel intrauterine system, other hormonal methods or non-hormonal medicines. Structural disease may need targeted intervention. Explain likely bleeding changes and review response, rather than presenting hysterectomy as the automatic first treatment for all patients.
05Amenorrhoea and follow-up
Exclude pregnancy where relevant before investigating absent periods. History may suggest hypothalamic suppression, polycystic ovary syndrome, endocrine disease or ovarian insufficiency. Select tests based on the clinical picture and refer when indicated. Document the plan for results and persistent symptoms, including worsening bleeding, anaemia or a new pattern that changes the differential.
High-Yield Revision
- Bleeding impact and associated symptoms guide assessment.
- Pregnancy remains relevant in abnormal bleeding or amenorrhoea.
- Treatment should reflect fertility goals and preferences.
Common Pitfalls
- Assuming a fibroid explains every new bleeding symptom.
- Using cervical screening to exclude all gynaecological pathology.
References & Further Reading
Read the relevant guideline sections alongside these original clinical teaching cases. Local pathways, available services and individual patient factors determine care.
Reference review: 28 September 2026. Consult current local protocols for prescribing, procedures and escalation.