Menorrhagia
Define menorrhagia.
Bleeding ≥7 days or blood loss >80 mL per cycle.
Source: American College of Obstetricians and Gynecologists [ACOG], 2021
What is secondary amenorrhea?
No periods for ≥3 months in a person who previously menstruated regularly
Source: ACOG, 2022; Hillard et al., 2023
What does a ferritin of 3 ng/mL indicate?
Iron deficiency
Source: Camaschella, 2015
What iron supplement was prescribed?
Ferrous sulfate 325 mg once daily or every other day.
What are common side effects of oral iron?
Constipation, dark stools, nausea.
Source: DeLoughery et al., 2024
What symptom from this patient suggests menorrhagia?
Soaking ≥5 overnight pads/day during the first 2 days of her period.
Source: ACOG, 2021
Why doesn’t this patient meet criteria for amenorrhea?
She has regular cycles; the issue is heavy flow, not absence.
Source: ACOG, 2022; Hillard et al., 2023
What does a hemoglobin of 6.6 suggest?
Severe anemia—consider transfusion if symptomatic.
Source: Carson et al., 2016
What medication reduces menstrual bleeding by helping blood clot?
Tranexamic acid (Lysteda)
Source: Djambas Khayat et al., 2020
Why is it important to continue iron therapy even after symptoms improve?
To fully replenish iron stores and prevent recurrence.
Source: Palacios, 2011
What past method helped regulate this patient's heavy bleeding?
Depot medroxyprogesterone [Depo-Provera] injection.
Source: ACOG, 2021
What postpartum condition may lead to amenorrhea or irregular bleeding?
Thyroid dysfunction—especially Hashimoto’s or postpartum thyroiditis.
Source: Alexander et al., 2017
What does a low TSH (0.37) suggest in a hypothyroid patient?
Possible overtreatment—iatrogenic hyperthyroidism.
Source: Garber et al., 2012; Jonklaas et al., 2021
Why was the patient’s levothyroxine dose lowered?
TSH was suppressed, indicating too much hormone
Source: DeLoughery et al., 2024
What should patients avoid taking near the time of iron supplements?
Calcium, dairy, tea, coffee, antacids.
Source: DeLoughery et al., 2024
Name two possible causes of heavy menstrual bleeding.
Possible causes include hypothyroidism, uterine fibroids, adenomyosis, and coagulopathy.
Source: Munro et al., 2011; ACOG, 2021
What psychosocial factor may also disrupt menstruation postpartum?
Postpartum depression or high stress.
Source: Schiller et al., 2015
What RBC indices suggest microcytic anemia?
Low MCV, low MCH, elevated RDW.
Source: Cappellini et al., 2020
How is oral iron best absorbed?
On an empty stomach with vitamin C or orange juice.
Source: DeLoughery et al., 2024
What safety teaching is needed for tranexamic acid?
Do not exceed 5 days per cycle; monitor for signs of blood clots.
Source: Djambas Khayat et al., 2020
What imaging was ordered to investigate structural causes?
Pelvic ultrasound—transabdominal and transvaginal.
Source: ACOG, 2021
What labs help assess causes of amenorrhea postpartum?
TSH, prolactin, pregnancy test, CBC.
Source: ACOG, 2022; Hillard et al., 2023
What pattern in iron studies confirms iron deficiency anemia?
Low iron, high TIBC, low % saturation, low ferritin.
Source: Camaschella, 2015
What type of therapy might be used if oral iron isn’t tolerated?
IV iron infusion.
Source: Moisidis-Tesch & Shulman, 2022
What dietary changes can support anemia recovery?
Eat iron-rich foods like leafy greens, beans, meats; add vitamin C sources.
Source: DeLoughery et al., 2024