Menorrhagia

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Menorrhagia is a menstrual period with a very heavy flow and is under the category of larger uterine bleeding (AUB).

Abnormal uterine bleeding may be caused by structural abnormalities in the reproductive tract, anovulation, bleeding disorders, hormonal problems (such as hypothyroidism) or reproductive tract cancers. Initial evaluation aims to determine the status of pregnancy, menopausal status, and source of bleeding.

Treatment depends on the cause, severity, and interference with the quality of life. Initial care often involves the contraceptive pill. Surgery can be an effective second-line treatment for women whose symptoms are not well controlled. About 53 out of 1000 women affected by AUB.

Video Menorrhagia

Signs and symptoms

A normal menstrual cycle is 21-35 days in duration, with a mean bleeding of 5 days and a total blood flow between 25 and 80 mL. Menorrhagia is defined as the total menstrual flow & gt; 80ml per cycle, or soak the pad/tampon every 2 hours or less. Deviations in the case of menstrual frequency, menstrual duration, or menstrual volume qualify as abnormal uterine bleeding. Bleeding between menstruation is also an abnormal uterine bleeding and therefore requires further evaluation.

Menorrhagia complications can also be an early symptom. Excessive bleeding can cause anemia that appears as fatigue, shortness of breath, and weakness. Anemia can be diagnosed by a blood test.

Maps Menorrhagia

Cause

Usually no causative abnormality can be identified and treatment is directed at a symptom, rather than a special mechanism. However, there is a known cause of abnormal uterine bleeding that needs to be excluded. The most common causes by nature of bleeding are listed below followed by causes of rare bleeding (ie coagulation disorders).

Considerations

• Menes overload but normal cycle:
  • Not painful:
    • Fibroids (leiomyomas) - fibroids in the uterine wall cause increased menstrual loss if they protrude into the central cavity and thereby increase the surface area of ​​the endometrium.
    • Coagulation defects (rare) - with shedding of endometrial lining of blood vessels, normal coagulation processes should occur to limit and eventually stop blood flow. Thrombocyte blood disorders (such as ITP) or coagulation (such as von Willebrand disease) or the use of anticoagulant drugs (such as warfarin) are a possible cause, although minorities are rare. The study of platelet function can also be used to confirm abnormal platelet function
    • Endometrial cancer (uterine cancer) - bleeding may also be irregular, between periods, or after menopause (postmenopausal bleeding or PMB)
    • Endometrial polyps
  • Painful:
    • Pelvic inflammatory disease
    • Endometriosis - an extension of endometrial tissue outside the uterus attempting to bleed out causing painful and abnormal bleeding
    • Adenomyosis - extension of the endometrial tissue to the uterine wall attempts to release causing painful and abnormal bleeding
    • Complications related to pregnancy (eg miscarriage)
• Short cycle (less than 21 days) but normal menstruation. This is always an anovulatory cycle due to hormonal disorders.
Short and excessive menstruation cycle due to ovarian dysfunction and may be secondary to clogging of blood vessels by the tumor.
• Menes are excessive and long intervals.
  • Ovarian anovulation disorders due to prolonged estrogen production.
  • This may occur following a continuous combination of oral contraceptive programs (eg, where some packets are taken without a withdrawal break to delay menstruation).
• Systemic causes: thyroid disease, excessive emotional/physical pressure

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Diagnosis

Diagnosis is mostly achieved by obtaining a complete medical history followed by physical examination and ultrasound. If necessary, laboratory tests or hysteroscopy may be used. The following is a list of diagnostic procedures that medical professionals can use to identify the causes of abnormal uterine bleeding.

• Examination of the pelvis and rectum to ensure bleeding does not originate from the lower reproductive tract (ie vagina, cervix) or rectum
• Pap smear to get rid of cervical neoplasia
• A pelvic ultrasound scan is a first-line diagnostic tool for identifying structural abnormalities.
• Endometrial biopsy to exclude endometrial cancer or atypical hyperplasia
• Hysteroscopy
• TSH and T4 doses to rule out hypothyroidism

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Treatment

If the underlying cause can be identified, treatment can be directed to this. Clearly severe periods during menarche and menopause can settle spontaneously (menarche becomes early and menopause becomes menstrual cessation).

If the level of mild bleeding, all that might be sought by women is the certainty that there is no underlying cause sinistanya. If anemia occurs due to bleeding then iron tablets can be used to help restore normal hemoglobin levels.

This condition is often treated with hormones, mainly due to abnormal uterine bleeding that usually occurs in the early and late menstrual periods when contraception is also sought. Oral contraceptive pills or progesterone may only be taken for several months, but for long-term treatment, an alternative to Prooa Provera or Progesterone injections that release the IntraUterine System (IUS) may be used. Fibroids can respond to hormonal treatments, and if not, surgery may be necessary.

Tranexamic acid tablets can also reduce losses by up to 50%. This can be combined with the hormonal drugs mentioned earlier.

Anti-inflammatory drugs such as NSAIDs may also be used. NSAIDs are the first-line drugs in menorrhagia ovulation, resulting in an average reduction of 20-46% in menstrual blood flow. For this purpose, NSAIDs are ingested only for 5 days of the menstrual cycle, limiting the most common side effects of dyspepsia.

The definitive treatment for menorrhagia is a hysterectomy (removal of the uterus). The risk of the procedure has been reduced by measures to reduce the risk of deep vein thrombosis after surgery, and the transition from the front abdominal approach to the vagina greatly reduces patient discomfort and healing time; However, extensive fibroids can make the uterus too large to be lifted through the vaginal approach. Small fibroids can be treated with local removal (myomectomy). The next surgical technique is the ablation of endometrium (destruction) by using thermoablation.

In the UK the use of hysterectomy for menorrhagia has been almost half between 1989 and 2003. It has a number of causes: better medical management, endometrial ablation and especially the introduction of IUS that can be incorporated into society and avoid the need for specialists. reference; in one study up to 64% of women canceled surgery.

Drugs

It has been rated by the UK National Institute for Clinical Health and Excellence:

• First line
  • Intrauterine devices with progesterone
• Second Row
  • Tranexamic acid antifibrinolytic agent
  • Non-steroidal anti-inflammatory drugs (NSAIDs).
  • Combined oral contraceptive pills to prevent endometrial proliferation
• Third line
  • Oral progestogens (eg norethisterone), to prevent endometrial proliferation
  • Progestogen injected (eg Depo provera)
• More options
  • Gonadotropin-releasing hormone agonist

Surgery

• Widening and curettage (D & amp; C) is no longer done for simple menorrhagia cases, having a spare role if spontaneous abortion is incomplete
• Endometrial ablation
• Uterine artery embolization (UAE)
• Hysteroscopic myomectomy to remove fibroids with diameters greater than 3 cm

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Complications

Aside from social difficulties in dealing with prolonged and prolonged periods, over time, blood loss may prove to be greater than iron body reserves or blood fill levels, leading to anemia. Symptoms caused by anemia may include shortness of breath, fatigue, weakness, tingling and numbness of the fingers and toes, headaches, depression, coldness, and poor concentration.

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See also

• Menometrorrhagia
• Metrorrhagia

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References

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Further reading

• Identify Evidence of Sustainable Research (WHO collaborative, and US CDC & Johns Hopkins Hospital) - Evidence Search on IUS
• Abnormal vaginal bleeding National Guideline Clearinghouse
• Menorrhagia - Menstrual Abnormalities and Abnormalities Abnormal Abnormal Bleeding and Abnormal Uterus Bleeding - Armenian Medical Network
• Abnormal uterine bleeding/dysfunctional uterine bleeding. Intracorp - Public For Profit Organization. 2005. Various pagings. NGC: 004390
• Workgroup on bleeding bleeding disorders rbdd - Database of Rare Bleeding Disorders
• Red Flag Information about Women and Bleeding Disorders
• [1] Adenomyosis Information from MayoClinic.com
• Working groups on Menorrhagia menorrhagia and other gynecological problems in women affected by bleeding disorders

Source of the article : Wikipedia