Causes of menorrhagia : 

A. Pelvic pathology : 

1. FIbroid uterus.
2. Adenomyosis.
3. Pelvic endometriosis.
4. IUCD in utero.
5. Chronic tubo- ovarian mass.
6. Retroverted uterus.

B. Systemic disease : 

1. Congestive cardiac failure
2. LIver dysfunction
3. Severe hypertension

C. Endocranial disorder : 

1. Hypothyroidism
2. Hyperthyroidism

D. Blood dyscrasias : 

1. ITP
2. Leukemia

Management of menorrhagia : 

History : 

1. Age of the patient
2. Quantity and quality of bleeding
3. Contraceptive history
4. HIstory of weight changes
5. History of any bleeding site
6. History of bleeding disorder
7. Systemic illnesses (hepatic or renal failure or diabetes)
   
8. Drug history like anticoagulant.
9. Family history of Tuberculosis

Examination of menorrhagia : 

General examination : 

1. Anaemia
2. Jaundice
3. Nutritional status
4. Hirsutism
5. Thyroid enlargement

Per abdominal examination : 

1. If primary – then no pathology will found.
2. If due to any specific cause then the finding will be according to the disease

Pelvic examination : 

1. Bi – manual examination : If primary, normal or slightly bulky uterus, non – tender fornices are free.
2. Per speculum examination: cervix is healthy looking.
3. Per – rectal examination : Rectal mucosa free.

Investigation  of menorrhagia:

Routine examination : 

1. Blood for complete blood count.
2. Tuberculin test
3. Chest X- ray P/A view
4. Hormones serum TSH, FT4, FSH, LH, Prolactin
5. Blood urea and serum creatinine
6. Diabetes screening
7. Ultrasonography of lower abdomen and pelvis to exclude any uterine or ovarian pathology.

Special Investigations : 

1. Diagnostic uterine curettage
2. Hysteroscopy
3. Laparoscopy
4. Hysterography

Treatment of menorrhagia : 

General treatment : 

1. Rest
2. Adequate explantation and reassurance
3. Psychological support
4. Correction of the anaemia.
5. Blood transfusion if required

Treatment of according to cause : 

=Primary : 

Hormone therapy : Norethisterone

Dose : 10-30 mg daily for 48 hours or until bleeding stops. After withdrawl

Norethisterone 5 mg daily from 5th  to 25 th day of the cycle.

Repeated for 3-6 cycle.

=Secondary : Appropriate treatment according to cause.