Practice BMJ Masterclass for GPs

Dysfunctional uterine bleeding

BMJ 2007; 334 doi: (Published 24 May 2007) Cite this as: BMJ 2007;334:1110
  1. Joan Pitkin, consultant gynaecologist and Royal College of Obstetricians and Gynaecologists tutor
  1. North West London Hospitals NHS Trust, Northwick Park Hospital, Middlesex, HA1 3UJ
  1. Joan.Pitkin{at}

    Practical tips

    • Dysfunctional uterine bleeding is a diagnosis of exclusion: other conditions such as uterine fibroids, endometrial polyps, and systemic diseases must be excluded by appropriate investigations

    • Tranexamic acid and mefenamic acid are among the most effective first line drugs for treating menorrhagia

    • Women needing contraception have a choice of combined oral contraceptive, levonorgestrel releasing intrauterine system, or long acting progestogens

    • Only 2% of endometrial carcinomas occur before age 40. Nulliparity, diabetes, obesity, and polycystic ovary syndrome are risk factors

    • Postmenstrual scans are often useful; the endometrium should be at its thinnest then, and polyps and cystic areas are more noticeable

    Dysfunctional uterine bleeding is defined as abnormal uterine bleeding in the absence of organic disease. It usually presents as menorrhagia without an underlying cause, and it affects women's health both medically and socially. Among women aged 30-49 years, one in 20 consults her general practitioner each year with menorrhagia; making dysfunctional uterine bleeding one of the most often encountered gynaecological problems. About 30% of all women report having had menorrhagia, and it accounts for two thirds of all hysterectomies and most endoscopic endometrial destructive surgery.

    Excessive menstrual bleeding has several adverse effects, including anaemia and iron deficiency, reduced quality of life, and increased healthcare costs because it is a major indication for referral to gynaecological outpatient clinics. Each year around £7m (€10m; $14m) is spent in the United Kingdom on prescriptions in primary care to treat menorrhagia.

    Menorrhagia …

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