Review Note

What are the indications for early referral (less than 6 months) in heavy menstrual bleeding?

- concurrent severe dysmenorrhoea at baseline
- concurrent dysmenorrhoea that does nto settle after 3 months of pharmacotherapy
- Individuals who wish to coneive in whom fertility may be at risk (if endo or adeno suspected)
- Fibroids greater than 3 cm
- Endometrial polyps
- Increased risk of endometrial cancer such as:
>> oligomenorrhoea
>> PCOS
>> personal or family history of endoemtrial or colon cancer
>> use of unopposed estrogen or tamoxifen 
>> Obesity 
>> age older than 45 years
>> radiological findings (such as endometrial thickness greater than 12mm in premenopausal indivudals or 5mm or greater in perimenopausal individuals, when measures in the first half of the menstrual cycle)