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N92.1 – Menorrhagia and Polymenorrhoea
N92.1 is the ICD-10 code for menorrhagia and polymenorrhoea – heavy and/or excessively frequent menstrual bleeding affecting women of reproductive age.
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N92.1 is the ICD-10 code for menorrhagia and polymenorrhoea – heavy and/or excessively frequent menstrual bleeding affecting women of reproductive age.
Definition
N92.1 is a diagnostic code from the International Classification of Diseases (ICD-10) that refers to menorrhagia and polymenorrhoea. Menorrhagia describes abnormally heavy menstrual bleeding, defined as a blood loss exceeding 80 ml per cycle. Polymenorrhoea refers to menstrual cycles that occur at intervals shorter than 21 days. Both conditions can occur together and significantly impact quality of life.
Causes
Several underlying conditions can contribute to menorrhagia and polymenorrhoea:
- Hormonal imbalances: Estrogen-progesterone imbalance, thyroid disorders, hyperprolactinaemia
- Structural uterine abnormalities: Uterine fibroids (leiomyomas), endometrial polyps, adenomyosis
- Coagulation disorders: Such as von Willebrand disease or platelet dysfunction
- Intrauterine devices (IUDs): Copper IUDs are associated with increased menstrual blood loss
- Endometriosis: Presence of endometrial-like tissue outside the uterus
- Medications: Anticoagulants and certain other drugs
- Idiopathic causes: No identifiable cause found in some cases
Symptoms
Common symptoms associated with N92.1 include:
- Excessively heavy menstrual flow requiring frequent changes of sanitary products
- Passing large blood clots during menstruation
- Menstrual cycles shorter than 21 days
- Fatigue and weakness due to iron-deficiency anaemia
- Pelvic pain and cramping
- Interference with daily activities and reduced quality of life
Diagnosis
Diagnosis involves a combination of clinical assessment and investigations:
- Medical history and gynaecological examination: Detailed evaluation of cycle pattern and bleeding severity
- Blood tests: Full blood count (haemoglobin, ferritin), coagulation profile, hormonal panel (FSH, LH, prolactin, thyroid function)
- Pelvic ultrasound: Assessment of uterus and ovaries for structural abnormalities
- Hysteroscopy: Direct visualisation of the uterine cavity to detect polyps or fibroids
- Endometrial biopsy: Tissue sampling to exclude endometrial pathology
Treatment
Treatment is tailored to the underlying cause and the severity of symptoms:
Medical Treatment
- Combined oral contraceptives or progestogen preparations: Regulate the cycle and reduce blood loss
- Levonorgestrel-releasing intrauterine system (hormonal IUS): Highly effective at reducing menstrual blood loss
- Tranexamic acid: Reduces bleeding by inhibiting fibrinolysis
- Non-steroidal anti-inflammatory drugs (NSAIDs): Such as ibuprofen – help relieve pain and moderately reduce blood loss
- Iron supplementation: Indicated when iron-deficiency anaemia is confirmed
Surgical Treatment
- Endometrial ablation: Destruction of the uterine lining; suitable for women who have completed their family
- Myomectomy or polypectomy: Surgical removal of fibroids or polyps
- Hysterectomy: Removal of the uterus as a last resort in severe cases where childbearing is no longer desired
References
- World Health Organization (WHO): International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10), Code N92.1 – Menorrhagia and Polymenorrhoea.
- National Institute for Health and Care Excellence (NICE): Heavy menstrual bleeding: assessment and management. NICE Guideline NG88 (2021). Available at: https://www.nice.org.uk/guidance/ng88
- Munro M.G. et al.: FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age. International Journal of Gynecology & Obstetrics, 113(1):3-13 (2011).
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