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349
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Abnormal uterine bleeding is a common problem. Menstrual blood loss is normally <80 mL (mean 30–40 mL). Menorrhagia is a menstrual loss of >80 mL per menstrual cycle.
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heavy bleeding, possibly with clots
if dysmenorrhoea, suspect endometriosis or PID
the most common cause is dysfunctional uterine bleeding, esp. ovulatory
the most common organic causes are fibroids and adenomyosis (endometrium in uterine myometrium); also, endometriosis, endometrial polyps and PID, but neoplasia and ectopic pregnancy must be excluded
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Various drugs can be implicated (e.g. hormone therapy, COCP, anticoagulants, cannabis, various steroids, some antihypertensives, heavy smoking).