Pre-menopausal menorrhagia, we have to find out any organic causes for it. So we have to do scans, hormonal tests to rule out, that there is no abnormality in the uterus, or any adenomyosis, or any hormonal changes or patient using any hormones. So investigate the patient to find out what is the cause. If there is an organic cause like fibriois, submucous fibroid, then it has to be removed, or if she is just reaching a menopause, hold on with some more months. So if an organic cause is found out, then you treat the organic cause. But if there is no organic cause for the Pre-menopausal menorrhagia, then to see if the endometrial lining is not very thickened. If the endometrial lining is thickened, then we have to send for an OPD biopsy called the piplle biopsy. It is done to make sure that the endometrial thickness is not related to any future cancer. If they are not, then just deal with the heavy bleeding. So organic cause and endometrial biopsy, these are done, we have to deal with the heavy bleeding. The first line of treatment is non-hormonal tablets like mefenamic acid, tranexemic acids. The second line of treatment called hormones. You can use a combination of estrogen, progesterone or a combination of progesterone. The third line of treatment is intrauterine device, a small T shaped thing with a progesterone in it, LNg progesterone is used, so everyday 20 mg of progesterone is used and the uterus is protected and the bleeding comes down very minimal. That is the third line of treatment. The fourth line is if this does not work, then you have to go in for a surgery. Surgically is ablating the uterus or a hysterectomy. So save the uterus is the first thing and for this all these lines of treatment can be used and plenty of counseling needs to be done.

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