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N92.4 – Premenopausal Menorrhagia & Metrorrhagia
N92.4 is the ICD-10 code for premenopausal menorrhagia and metrorrhagia – heavy or irregular uterine bleeding during the perimenopausal transition.
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N92.4 is the ICD-10 code for premenopausal menorrhagia and metrorrhagia – heavy or irregular uterine bleeding during the perimenopausal transition.
What Does the ICD-10 Code N92.4 Mean?
The ICD-10 code N92.4 refers to premenopausal menorrhagia and metrorrhagia. It is used to classify abnormal uterine bleeding in women who are in the transitional phase leading up to menopause, known as the perimenopause or climacteric. The term menorrhagia describes excessively heavy or prolonged menstrual bleeding, while metrorrhagia refers to irregular, acyclic bleeding occurring between periods. Both patterns may occur together.
Causes
During the premenopausal transition, significant hormonal fluctuations occur. Declining and erratic levels of estrogen and progesterone can disrupt the normal menstrual cycle. Common underlying causes include:
- Hormonal imbalance: Anovulatory cycles lead to relative estrogen excess and progesterone deficiency.
- Uterine fibroids (leiomyomas): Benign muscle tumors of the uterus that can increase bleeding.
- Endometrial polyps: Benign growths of the uterine lining.
- Adenomyosis: Endometrial tissue growing into the uterine muscle wall.
- Endometrial hyperplasia: Thickening of the uterine lining due to prolonged estrogen stimulation.
- Coagulation disorders: Conditions such as von Willebrand disease may contribute.
- Malignancy: Endometrial carcinoma must be excluded, particularly in women with postmenopausal or unexplained bleeding.
Symptoms
The main symptoms associated with N92.4 include:
- Very heavy menstrual bleeding (requiring pad or tampon changes every hour)
- Prolonged bleeding lasting more than 7 days
- Intermenstrual spotting or breakthrough bleeding
- Iron-deficiency anemia causing fatigue, pallor, and reduced performance
- Pelvic pain or a feeling of pressure in the lower abdomen
Diagnosis
Diagnosis is made by a gynecologist and typically involves the following steps:
- Medical history: Detailed assessment of bleeding pattern, frequency, and severity.
- Gynecological examination including cervical smear (Pap test)
- Transvaginal ultrasound: Assessment of endometrial thickness, fibroids, and polyps.
- Blood count and coagulation studies: To rule out anemia and clotting disorders.
- Hormone panel: FSH, LH, estradiol, progesterone, TSH (thyroid function).
- Hysteroscopy and endometrial biopsy: Indicated when structural abnormalities or malignancy are suspected.
Treatment
Treatment depends on the underlying cause and the severity of symptoms:
Conservative (Non-surgical) Treatment
- Hormonal therapy: Progestogens, combined oral contraceptives, or a hormonal intrauterine device (e.g., levonorgestrel IUD) to regulate bleeding.
- Non-hormonal therapy: Tranexamic acid to reduce blood loss; non-steroidal anti-inflammatory drugs (NSAIDs) for painful bleeding.
- Iron supplementation: Required when iron-deficiency anemia is confirmed.
Surgical Treatment
- Hysteroscopic removal of polyps or submucosal fibroids
- Endometrial ablation: Destruction of the uterine lining for treatment-resistant cases.
- Hysterectomy: Surgical removal of the uterus as a last resort in severe, refractory cases.
References
- World Health Organization (WHO): ICD-10 International Statistical Classification of Diseases and Related Health Problems, 10th Revision – N92 Excessive, frequent and irregular menstruation. WHO, Geneva, 2019.
- Munro MG et al.: FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age. International Journal of Gynaecology and Obstetrics, 2011; 113(1): 3–13.
- National Institute for Health and Care Excellence (NICE): Heavy menstrual bleeding: assessment and management. NICE Guideline NG88, 2018 (updated 2021).
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