Menorrhagia Seminar 7

8/4/2019 Menorrhagia Seminar 7

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Mohd Helmy B Abu Bakar

012010050487

Year 4 MBBS-MSU


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Disorders of menstrual cycleTopic covered:

1. Menorrhagia

2. Dysmenorrhea

3. Amenorrhea/oligomenorrhea

4. Polycystic ovarian syndrome

5. Post menopausal bleeding6. Premenstrual syndrome


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Menorrhagia/Heavy menstrual

bleeding


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Definition

Menorrhagia can be defined as a complaint of

heavy cyclical menstrual blood loss over

several consecutive menstrual cycles in a

woman of reproductive years, or more

objectively, a total menstrual blood loss of

more than 80 ml per menstruation


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Prevalence

Extremely common

5% of women within the ages of 30 and 49

years old


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Atielogy

Fibroids

Endometrial polyps

Coagulation disorders eg: von Willebrands

disease Pelvic inflammatory disease (PID)

Thyroid disease

Drug therapy eg: warfarin

Intrauterine contraceptive devices (IUCDs)

Endometrial/ cervical carcinoma


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Uterus fibroid


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Endometrial polyp


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Clinical features

History

Hallmark of menorrhagia is complaint of regularexcessive menstrual loss over several consecutive

cycles Discussion of the numbers of the towels and

tampons used per day (menstrual pictogram)

Impact of the condition on the patients lifestyle

and quality of life (severity) Duration of current problem and any other

symptoms


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Other symptoms :

Irregular

Intermenstrual or post coital bleeding

Change in symptoms

Dyspareunia

Pelvic or premenstrual pain

Excessive bleeding from other sites eg: aftertooth extraction


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Clinical examination

Sign of anemia, obesity, thyroid

Abdominal and pelvic examination Swabs and cervical smears


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Investigation

1. FBC

2. Coagulation screen

3. Pelvic ultrasound Pelvic mass palpated

Symptoms suggest endometrial polyps

Drug therapy failed

4. Endometrial biopsy (pipelle) Aged > 45 years

Irregular or intermenstrual bleeding

Drug therapy failed

5. Thyroid function test Only performed when the history is suggestive of a thyroid disease


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Pipelle endometrial sampler


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Management

When selecting appropriate management for thepatient, it is important to consider and discuss:

The patients preference of treatment

risk/benefits of each option Contraceptive requirements:

Family complete?

Current contraception?

Past medical history:

Any contraindication to medical therapies

Suitability for an anesthetic


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Medical treatment

1. Mefenamic acid and NSAIDS (500mg p.o tds)Advantages: effective anegesia 1st line treatmentwhen dysmenorrhea coexist

Disadvantages: contraindicated for duodenal ulcer

or severe asthma2. Tranexamic acid (1g p.o qds)

3. Combined oral contraceptive pill (COCP)

Advantages: doubles up as a very effective when

taken properlyDisadvantages: contraindicated for

thromboembolism, ages > 35 who smokes, breastcancer, grossly overweight


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4. Norethisterone (5-10mg tds on day 6-26)

5. Levonogastrel intrauterine system (LNG-IUS)

6. GnRH agonist:

Gasorelin 3.6mg monthly subcutaneous

implant

Decapeptyl 3mg monthly s/c or im

Buserelin 300g nasal spray tds

7. Danazol


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LNG-IUS/mirena


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Surgical management

1. Endometrial ablation

2. Hysteroscopic resection polyp / fibroid

3. Hysterectomy


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Endometrial ablation


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Endometrial ablation


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Fibroid resection


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Complications

Excessive or prolonged menstrual bleeding can

lead to other medical conditions, including:

Severe pain

Infertility

Toxic shock syndrome

Anemia


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Thank you

Documents

Menorrhagia Seminar 7