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Menses
Posted ByDr. Manisha BhatiaOn August 31, 2015 @ 11:02 am In Disease Index,Featured | 5
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Measured blood loss has been shown to have little correlation with women’s own perceptions
of bleeding heaviness and so the clinical definition typically used is that of excessively heavy
bleeding for an individual.
Various methods have been developed for the objective assessment of menstrual loss. These
have not been very helpful in the clinical management of Menorrhagia.
Menorrhagia may start anytime from menarche through the reproductive years to
menopause and in the postmenopausal women on hormone replacement therapy. It can
start suddenly or run a chronic course.
During the normal menstrual cycle, proliferation of endometrium is induced by the effect of
oestrogens, while progestogens induce secretory differentiation. For menstruation to occur
there is extensive arteriolar vasoconstriction and bleeding occurs as vessels dilate.
The causes of Menorrhagia can vary from a dysfunctional aetiology to the existence of pelvic
pathology and rarely to systemic disorders.
Apart from the social and psychological effects of Menorrhagia, the severity can be assessed
by estimation of the hemoglobin level and other blood indices and the effect on the iron
status. Menorrhagia is the commonest cause of iron deficiency anaemia in the
reproductive age women.
Cause of Menorrhagia
The causes of Menorrhagia can be categorized into three main groups, namely:
General causes
Systemic disease occasionally causes Menorrhagia. Systemic causes of Menorrhagia can vary
from
Pelvic pathology
Uterine fibroids
Adenomyosis
Endometrial polyps
Endometriosis
Endometritis;
Presence of intra-uterine contraceptive device (IUCD)
Endometrial hyperplasia;
Rarely, endometrial cancer.
Contraceptive uses
IUCD
Poststerlisation menorrhagia
Progestogen – only pills
Hormonal or dysfunctional
Ovulatory
Anovulatory
Anovulatory cycles (oestrogen withdrawl)
Metropathia haemorrhagica
Large submucous fibroids and pedunculated fibroid polyps are associated with the heaviest
degree of loss.
Symptoms of Menorrhagia
The word Menorrhagia means excessive flow of blood during the menstruation. In this
condition the menstrual period may be regular as to time, or it may come too early, or it may
last too long.
Excessive flow of blood produces paleness of face, sunken eyes, and is usually attended with
lassitude, a sense of oppression in the head, wandering pains in the lack, loins, and lower
extremities: sense of weight and pressure in the pelvis; chilliness, cold feet, weak sight, weak
pulse and impaired appetite.
Assessment of Menorrhagia
History
The number of sanitary towels used, duration of bleeding, or passage of clots has been shown
to have little or no correlation with actual blood lost. However, complaints of ‘flooding’
(leakage of heavy blood onto clothes are indicative of heavy menstrual loss.
Similarly, severity of bleeding can be assessed by determining the impact it has on the
individuals’ quality of life. It is important therefore, to ask about the degree of disability
experienced, such as time lost from work, or becoming housebound during menses owing to
fear of social embarrassment from an episode of flooding in public.
The patient should also be questioned about symptoms suggestive of anaemia. A history of
irregular bleeding, dyspareunia, pelvic pain, inter-menstrual or postcoital bleeding may
raise the suspicion of underlying pathology.
Pelvic ultrasound may be particularly useful in specific situation and may provide
information to support a specific diagnosis. Ultrasound examination is less satisfactory at
identifying areas of endometriosis or inflammation accompanied by anatomical distortion
from complications.
Sampling the endometrium in the surgery can be a useful procedure if a positive result is
obtained. If it is negative then a further procedure is indicated. Endometrial sampling via
the hysteroscope remains the gold slandered to check the endometrial pathology.
Endometrial assessment should be performed in all women > 40 years, or younger women
with persistent Menorrhagia, irregular bleeding, or for whom there are risk factors for
endometrial cancer. This can take the form of an endometrial biopsy or a hysteroscopy,
both of which can be carried out either as an outpatient or inpatient.
A dilatation and curettage is a diagnostic and not a therapeutic test, and should be
accompanied by a hysteroscopy. The endometrial pathologies that can be diagnosed by
hysteroscopy include:
Submucous fibroids,
Polyps,
Hyperplasia,
Malignancy.
Thyroid function tests and tests of coagulation should only be performed if there are
features suggestive of this in the history. No other endocrine tests are necessary.
A cervical smear should be taken if one is due, or if the cervix looks clinically suspicious.
This is the only way through which a state of complete health can be regained by removing
all the sign and symptoms from which the patient is suffering.
The aim of homeopathy is not only to treat menorrhagia but to address its underlying cause
and individual susceptibility. As far as therapeutic medication is concerned, several remedies
are available to treat menorrhagia that can be selected on the basis of cause, sensations and
modalities of the complaints.
For individualized remedy selection and treatment, the patient should consult a qualified
homeopathic doctor in person. There are following homeopathic remedies which are helpful
in the treatment of menorrhagia:
Cimicifuga / Actea racemosa: menses are profuse and too early, sometimes twice a month;
blood is dark coagulated; there is bearing down and pressing pains in the uterine region; this
pain traverses from hip to hip.
Severe pains in lower extremities; backache after menstruation, with heavy pressing down
sensation. Shooting and throbbing pains in head as a reflux of uterine bleeding; nausea and
vomiting caused by pressure on the spine.
Sabina patient is so much depresses that she cries when questioned; sensation as if some
weight is laid on her head; almost all the symptoms are due to fear and she is worse during
menstrual flow. The mental symptoms are intermingled with rheumatism. Mental symptoms
are worse during menses.
Belladonna: Menses too early and profuse. Violent pressing down, as if everything would
escape through the genitals. The discharge is bright red, with a sensation of heat. Sometimes
it has bad door with lumps. Congestion to the head, throbbing headache and pain in the small
of the back.
Calcarea carb.: Menstruation too soon, too profuse and lasting too long. Vertigo when
stooping, worse on rising or going upstairs. Feet feel as if they had cold and damp stockings.
Preceding the flow, there may be swelling and sensitiveness of the breasts, headache, colic
and shivering.
During the flow, cutting in the abdomen, toothache, and bearing down. The means are dark
colored or black and thick.
China: Menses too profuse with a flow of dark clots. Great distension of abdomen not
relieved by eructations or passing of flatus. Frequent desire to urinate; pale urine. Ringing in
ears and fainting spells.
Erigeron: it is a very good remedy for hemorrhages of all kinds, but like all homeopathic
remedies, it will show effect if prescribed on totality. The hemorrhage of this remedy,
immaterial from which orifice it may take place, is cauterized by the bright redness of the
discharge.
In cases of menorrhagia this bright red bleeding is associated with dysuria (painful urination)
and irritation of the rectum.
Ferrum met: Iron is the main component of the human blood and this homeopathic remedy
is best adapted to anaemic people. It is either a cachectic state, due to faulty nutrition and
assimilation or simple deficiency of blood due to hemorrhages.
Menses are too profuse and too long lasting and all through this time, face looks fiery red
with ringing in ears. The copiousness of the discharge forbids all movement, as the least
movement aggravates the flow. Patient is extremely debilitated.
Ipecac: The principal feature of Ipecac is its persistent nausea and vomiting but it is also a
great anti hemorrhagic medicine. Hemorrhages are bright red, profuse and steady in flow.
Menorrhagia is accompanied with nausea and characteristic pain from navel to uterus.
Coccus Cacti: Menses too early, profuse, black and thick. Flow only in the evening and at
night. Large clots escape when passing urine.
Cyclamen: Menses are profuse, black and membranous. Menses comes early and give
certain relief in her mental symptoms. Post partum haemorrahage with severe labour like
pain. Irregularities in menses associated with migraine and blindness.
Iodium: Menorrhagia due to endocrine dysfunction ,especially of the thyroid gland; the
synthesis of thyroxin is hampered in these patients; menstruation is irregular; uterine
hemorrhage; menorrhagia with enlarged and indurated uterus.
Iodum may be thought of when hemorrhage is due to pathological condition of uterus; there
is acute catarrh of endometrium; great weakness during menses, wedge like pain in right
ovarian region; hemorrhage occurring at every stool with cutting pain in the abdomen, pain in
the loins and small of back.
Patient shows signs of rapid metabolism. Loss of flesh with great appetite. Hot patient, better
by cold; patient wants to move all the time as the symptoms are relieved when she is busy.
These pains are associated with bearing down or labor like pains; pain traverse from vagina
to uterus; discharge of blood between periods with sexual excitement; inflammation of the
tubes, ovaries and uterus; uterine fibroids are usually the cause of menorrhagia at the
climacteric age; profuse leucorrhoea and the discharge is bloody.Patient is nervous sad and
depressed. music makes her nervous; also music is intolerable for her.
Secale cor.: Menses are too profuse and too long lasting with violent spasms. Discharge
dark, liquid blood, increased by motion. All her symptoms are worse just before the menses.
Suitable to thin women. Continuous oozing of watery blood until next period.
Nux Vomica: Menses too early and profuse; discharge of dark colored blood. The discharge
after continuing for several days, stops and then returns. Cramp like pains in the abdomen,
extending down to the thighs. She gets angry and violent without provocation. Habitual
constipation, with frequent urging to stool.
Thalaspi bursa: too copious and too frequent menses usually due to uterine fibroid.
Bruised, sore feeling in the back with menses. Every alternate menses is copious.
Trillium pendulm: It has been used with great success in all kind of uterine hemorrhages -
anti partum, post partum and climacteric. The characteristic of this hemorrhage is its
association with faintness and dizziness. Bleeding aggravates with least motion.
Xanthoxylum: menses too early and profuse; menstrual blood is almost black, comes in
strings and with clots. It is an excellent remedy for neuralgic dysmenorrhoea; violent
agonizing, grinding pain not ameliorated by anything; pain goes to thighs or radiate over
whole body.
Измерената загуба на крв се покажа дека има мала корелација со сопственото сфаќање
на жените за сериозноста на крварењето и затоа клиничката дефиниција што обично се
користи е онаа на претерано тешко крварење за една личност.
Во пракса, секоја загуба на крв што жените ја сметаат за претерана или има негативно
влијание врз нејзиниот квалитет на живот, по советува за совет и можеби третман.
Општи причини
Карлична патологија
Матки fibroids
Аденомиоза
Ендометријални полипи
Ендометриоза
Ендометритис;
Присуство на интра-маткарен контрацептивен уред (IUCD)
Ендометријална хиперплазија;
Ретко, карцином на ендометрија.
Контрацептивни употреба
IUCD
Менорагија постстерлизацијата
Прогестоген - само апчиња
Овулаторно
Симптоми на менорагија
Зборот Менорагија значи прекумерен проток на крв за време на менструацијата. Во
ваква состојба, менструалниот период може да биде редовен, или може да дојде
премногу рано, или може да трае предолго.
Проценка на менорагија
Историја
Пациентот исто така треба да биде сослушан за симптоми кои укажуваат на анемија.
Историја на неправилно крварење, диспареунија, болки во карлицата, интер-
менструално или постцеоитално крварење може да го покрене сомневањето за
основната патологија.
Ендометријална проценка треба да се изврши кај сите жени> 40 години или помлади
жени со постојана менорагија, неправилно крварење или за кои има фактори на ризик
за рак на ендометрија. Ова може да биде во форма на ендометријална биопсија или
хистероскопија , и двете може да се спроведат или како амбулантско или
хоспитализирано.
Поткожни фиброиди,
Полипи,
Хиперплазија,
Малигнитет.
Треба да се земе измазнување на грлото на матката ако се должи, или ако грлото на
матката изгледа клинички сомнително.
Ова е единствениот начин преку кој може да се врати состојба на целосно здравје со
отстранување на сите знаци и симптоми од кои страда пациентот.
Пациентот Сабина е толку депресивен што плаче кога е испрашувана; сензација како
да се стави малку тежина на главата; скоро сите симптоми се должат на страв и таа е
полоша за време на менструалниот проток. Менталните симптоми се испреплетени со
ревматизам. Менталните симптоми се полоши за време на менструациите.
Едикон: тоа е многу добар лек за крварења од сите видови, но како и сите хомеопатски
лекови, тој ќе покаже ефект доколку е пропишано на тоталитет. Крварењето на овој
лек, нематеријално од кое може да се случи отворот, е каутризирано со светло
црвенило на празнењето.
Coccus Cacti : Менс премногу рано, профузно, црно и густо. Тече само во вечерните
часови и во текот на ноќта. Големи згрутчувања избегаат кога поминуваат урина.
Сабина : Тоа е одличен лек против хеморагичен лек; Сабина делува на мукозната
мембрана на матката и на серозните мембрани; болка лета од сакрум до пубис.
хеморагијата е изобилна за време на менструацијата; тие се долготрајни, делумно
флуидни и делумно згрутчени, навредливи по природа; крвта доаѓа во гуски;
интензивни колики на болки во стомакот за време на менструации.
Овие болки се поврзани со слабеење или труд како болки; болка траверз од вагината до
матката; празнење на крв помеѓу периоди со сексуална возбуда; воспаление на
цевките, јајниците и матката; матката fibroids обично се причина за менорагија во
климактериска возраст; изобилна леукореја и празнењето е крваво. Пациентот е
нервозен тажен и депресивен. музиката ја прави нервозна; исто така музиката е
неподнослива за неа.