Menorrhagia (excessive bleeding).
Menorrhagia
Define menorrhagia : Menorrhagia is a cyclical bleeding at normal level which is excessive in amount or duration.
We have described :
Causes of menorrhagia
Management of menorrhagia
Examination of menorrhagia
Investigation of menorrhagia
Treatment of menorrhagia
Hormone therapy for menorrhagia
Causes of menorrhagia :
A. Pelvic pathology :
- FIbroid uterus.
- Adenomyosis.
- Pelvic endometriosis.
- IUCD in utero.
- Chronic tubo- ovarian mass.
- Retroverted uterus.
B. Systemic disease :
- Congestive cardiac failure
- LIver dysfunction
- Severe hypertension
C. Endocranial disorder :
- Hypothyroidism
- Hyperthyroidism
D. Blood dyscrasias :
- ITP
- Leukemia
Management of menorrhagia :
History :
- Age of the patient
- Quantity and quality of bleeding
- Contraceptive history
- HIstory of weight changes
- History of any bleeding site
- History of bleeding disorder
- Systemic illnesses (hepatic or renal failure or diabetes)
- Drug history like anticoagulant.
- Family history of Tuberculosis
Examination of menorrhagia :
General examination :
- Anaemia
- Jaundice
- Nutritional status
- Hirsutism
- Thyroid enlargement
Per abdominal examination :
- If primary – then no pathology will found.
- If due to any specific cause then the finding will be according to the disease
Pelvic examination :
- Bi – manual examination : If primary, normal or slightly bulky uterus, non – tender fornices are free.
- Per speculum examination: cervix is healthy looking.
- Per – rectal examination : Rectal mucosa free.
Investigation of menorrhagia:
Routine examination :
- Blood for complete blood count.
- Tuberculin test
- Chest X- ray P/A view
- Hormones serum TSH, FT4, FSH, LH, Prolactin
- Blood urea and serum creatinine
- Diabetes screening
- Ultrasonography of lower abdomen and pelvis to exclude any uterine or ovarian pathology.
Special Investigations :
- Diagnostic uterine curettage
- Hysteroscopy
- Laparoscopy
- Hysterography
Treatment of menorrhagia :
General treatment :
- Rest
- Adequate explantation and reassurance
- Psychological support
- Correction of the anaemia.
- 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.
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