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Which of these statements are true?
- Menorrhagia is objectively defined as a blood loss of 40ml or more per menstrual cycle
- When menstrual loss is measured in women who complain of menorrhagia, approximately half of them have blood loss of less than 80ml
- Menorrhagia affects about 22 per cent of otherwise healthy premenopausal women aged over 35 years in the UK
- About 5 per cent of women aged 30-49 years present to their GP with this problem annually
Which of these factors are believed to play a causative role in excessive blood loss in women with menorrhagia?
- Presence of a copper IUD
- Submucosal fibroids
- Anovulation
- Endometrial vasoconstriction
Which of these statements are regarding the assessment of menorrhagia?
- NICE guidance suggests that where heavy bleeding occurs in isolation physical examination or other investigation are essential prior to commencing treatment
- Serum ferritin should be measured routinely
- A uterus that is palpable abdominally is an indication for an ultrasound scan
- Clotting disorders should be considered in women who have experienced heavy menstrual bleeding since menarche
Which of these statements about the levonorgestrel-releasing intrauterine system are true?
- It should be considered as first-line therapy provided 12 months' use is anticipated
- It does not provide effective contraception in women with menorrhagia
- Efficacy is similar to that of endometrial ablation techniques
- Its progestogenic effects have not been shown to significantly impair quality of life in women with menorrhagia
Which of these statements about non-hormonal medical treatments for menorrhagia are true?
- Tranexamic acid and NSAIDs are taken only during the days of menstruation
- Tranexamic acid is generally more effective than an NSAID
- Mefenamic acid is the most effective NSAID overall
- Paracetamol is no better than placebo
Which of these statements about hormonal medical treatments for menorrhagia are true?
- A combined hormonal contraceptive is an appropriate treatment for menorrhagia in women in their 40s
- A combined hormonal contraceptive reduces menstrual blood volume by about half and reduces pain
- Progestogens induce endometrial atrophy when taken over an extended period
- Progestogens enable women to manipulate the timing of bleeding
Which of these statements about hormonal medical treatments for menorrhagia are true?
- Progestogens are most effective when given from days 5 to 26 of the menstrual cycle inclusive
- Gonadotrophin-releasing hormone (GnRH) analogues are not useful for long-term treatment alone as they cause a menopausal hypo-oestrogenic state
- Danazol is a progestogen with no androgenic activity
- Gonadotrophin-releasing hormone (GnRH) analogues may have a deleterious effect on bone mass but only after at least one year's use
Which of these statements about the surgical management of menorrhagia are true?
- After endometrial ablation, e ndometrial regeneration is less likely in younger than older women
- Endometrial ablation is a cost-effective alternative to hysterectomy, with fewer complications
- A bdominal hysterectomy is associated with a longer recovery time but fewer complications than vaginal hysterectomy
- Overall satisfaction rates after hysterectomy for menorrhagia are in the order of over 95 per cent three years after surgery

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