menorrhagia

DR MANAL IDRIS
 Introduction
Menorrhagia is one of the commenest gynaecological
complaints seen in practice and accounts for
approximately 12% of all referrals to gynaecology
.clinic
Among women aged 16-35 yr it has an incidence of
.around 30%
 Definetion
The average menses lasts for 3-7 days with interval
.21-35 days and mean blood loss of 35 ml
Menorrhagia is generally defined as prolonged and
. increased menstrual flow of greater than 80 ml
 Aetiology
Non organic causes : dysfunctional uterine -
. bleeding (DUB)
.Organic causes -
.Systemic disorders -
DUB Non –organic causes
anovulatory :occure in women at the extremes of
reproductive age ,menorrhagia with irregular
. interval
Ovulatory:(90%) common in women aged 35-45yr
.and it is regular period
It may be due to inadequate production progesterone
in luteal phase or due to imbalance between PGs on
.the myometrial and endometrial vasculature
Organic causes
fibroids -
adenomyosis -
endocervical \endometrial polyps -
endometrial hyperplasia -
IUCD -
pelvic inflammatory disease(PID) -
malignancy of CX or uterus -
hormone producing tumours:eg,granulosa cell of -
. the ovary
Systemic disorders
endocrine disease :DM,hyper or hypothyroidism -
. ,adrenal disease
disorders of haemostasis:eg ,von willebrands -
.disease ,ITP
.liver disease -
.renal disease -
.drugs:steroid hormones,anticoagulants -
:Management

.HISTORY
.EXAMINATION
.INVESTIGATION
.TREATMENT
-:History include the following

Age -
menses pattern -
Quantity and quality of bleeding involves the -
presence of clots and flooding
exclusion of pregnancy -
. pelvic pain and pathology -
.sexual activity and post coital bleeding -
contraceptive use IUCD or hormonal -
hirsutism -
galactorrhea -
Systemic disease (hepatic \renal failure , DM,) -
Symptoms of thyroid dysfunction -
Excesive brusing or bleeding disorders -
Current medications hormonal or anticoagulant -
 Examination
:General examination
Signs of anemia -
Obesity -
Signs of androgen excess -
Ecchymosis and purpura -
Visual field -
Thyroid evaluation -
:Abdominal examination
abdomino-pelvic mass -
Enlarged liver or spleen -
:Pelvic examination
speculum ex,bimanual palpation
 Investigation
CBC -
Serum BhcG -
Thyroid function test -
Prolactin -
Serum androgen -
Coagulation screen -
-Renal \liver function test-
US(abdominal-transvaginal) -
 Endometrial sampling
It is an integral component of evaluating abnormal
uterine bleeding ,particularly in women more than
: 35yr old
- hystroscopical directed biopsy .
- D\C.
- endometrial aspiration.
 Treatment
: Medical treatment
PG synthesis inhibitors (eg:mefanamic acide) reduces-
mean blood loss 20-40%
antifibrinolytics eg,tranxenamic acide reduces blood loss-
.50%
progestogens :eg,medroxyprogesterone acetate-
reduces blood loss 15-30%)provera(
COCs :reducing blood loss 50%-
danazol:reduces blood loss 60%-
GnRH analogues:eg,goserelin-
levenorgestral –releasing IUCD-
 Surgical treatment

Endometrial resection and ablation:eg

TCRE(transcervical endometrial resection)-
laser-
diathermy-
thermal balloon ablation-
radiofrequency endometrial ablation-
microwave endometrial ablation-
:Criteria
age more than 35 yr old-
ut less than 10 week in size-
performed during proliferative phase-
DUB,no endometriosis or adenomyosis-
:Hysterectomy
total abdominal hysterectomy-
subtotal hysterectomy-
vaginal hysterectomy-
laparoscopic –assisted vaginal hysterectomy-
laparoscopic hysterectomy-
THANKS