وصف
Menorrhagia refers to abnormally heavy or prolonged menstrual bleeding, often causing disruption to a woman's daily life. Diagnosis involves a thorough medical history, including menstrual patterns and related symptoms, followed by a physical examination. Blood tests, such as complete blood count (CBC), might be performed to check for anemia due to excessive bleeding. Imaging techniques like ultrasound may help identify structural abnormalities in the uterus or pelvis that could contribute to menorrhagia.
Endometrial biopsy might be recommended to rule out conditions like endometrial hyperplasia or cancer. Keeping a menstrual diary can assist in tracking bleeding patterns, aiding the diagnosis process. Management options depend on the underlying cause, severity of symptoms, and patient preferences. Nonsteroidal anti-inflammatory drugs (NSAIDs) can help alleviate pain and reduce menstrual flow by inhibiting prostaglandin production.
ملخص
- Menorrhagia is defined as excessive menstrual blood loss that interferes with a woman's physical, emotional, social, and material quality of life. The normal menstrual cycle ranges from 25 to 35 days, with an average of 28 days, and blood flow typically lasts 3 to 7 days with an average blood loss of 80 ml.
- Causes of menorrhagia can be structural (PALM) or non-structural (COEIN). PALM encompasses polyp, adenomyosis, leiomyoma (fibroids), and malignancy and hyperplasia. COEIN includes coagulopathy, ovulatory dysfunction, endometrial causes, iatrogenic causes, and not otherwise classified causes.
- Diagnosis of menorrhagia includes a thorough history to assess symptoms of anemia, thyroid disease, bleeding disorders, and current medications. Examination involves evaluating pallor, thyroid, abdominal palpation for pelvic masses, speculum examination for cervical pathology, and bimanual examination to assess uterine size.
- Investigations include a complete blood count (CBC), platelet count, thyroid studies, and clotting studies for specific cases. Transvaginal ultrasound is preferred to identify structural abnormalities like fibroids, adenomyosis, and endometrial polyps. Endometrial biopsy and hysteroscopy are used in non-responsive cases or when malignancy is suspected.
- Medical treatment options for menorrhagia include non-hormonal and hormonal approaches. Non-hormonal treatments involve NSAIDs like tranexamic acid, and hormonal treatments include progestogens, levonorgestrel-releasing intrauterine systems (Mirena), combined oral contraceptives, and GnRH agonists.
- Surgical treatment options consist of endometrial ablation, myomectomy, uterine artery embolization, and hysterectomy. Endometrial ablation destroys the basal endometrium, while myomectomy surgically removes fibroids. Uterine artery embolization is a minimally invasive technique to reduce fibroid size, and hysterectomy is the last resort.
- Obesity, low estrogenic diets, and dietary changes impact menorrhagia, with obesity potentially leading to hormonal irregularities and anovulation. Dietary changes can include reducing animal protein and increasing vegetarian foods, seeds, and millets.
- Menorrhagia impacts fertility preservation, with different causes having varying effects. Endometrial polyps can hinder implantation, while adenomyosis and submucosal fibroids contribute to subfertility. Treatment is individualized, considering the patient's reproductive needs and overall condition.
نموذج شهادة
حول المتحدثين
الدكتورة إيشا راني
Consultant Obstetrics and Gynecology, Laparoscopic surgeon· Asarfi Hospital, Jharkhand
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