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MENORRHAGIA – AN OVERVIEW
M.S;FICOG;FICMU,FICMCH,Dip.Lap.Surg
(Germany);Dip.Ultrasound (New Zealand)
ASSOCIATE PROFESSOR ,
MUKESH
•5% women aged 30-49 consult their Gynaecologists annually with menorrhagia.
•Only 58% of women receive medical therapy for menorrhagia before referral to a
specialist.
• 60% of women with menorrhagia will have a hysterectomy within five years.
• One in five women will have a hysterectomy before the age of sixty.
• In 50% who undergo hysterectomies menorrhagia is the main presenting problem.
•Upto 50% of women who present with menorrhagia have blood losses within a
normal range
• 30% of all women undergoing hysterectomy for menorrhagia have a normal uterus
removed.
•Such variation in the management of a common complaint is an indication for
guideline development
How do we define menorrhagia ?
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Menorrhagia can be defined objectively or subjectively
Objectively, menorrhagia is taken Subjectively, menorrhagia is
to be a total menstrual blood loss – defined as a complaint of
excessive menstrual blood loss
80 ml per menstruation occurring over
several consecutive cycles in a
woman of reproductive years
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Complexity of menorrhagia?
• Menorrhagia— is the medical term for
excessive or prolonged menstrual
bleeding or both
• The condition also is known as
hypermenorrhea
• The menstrual cycle isn't the same for
every woman
• Normal menstrual flow occurs about every
28 days, lasts about 5 days and produces
a total blood loss of 30 to 40 milliliters
• Some women have frequent menstrual
spotting, while others find that heavy
bleeding is normal
• Between 15 and 20 percent of healthy
women experience debilitating
menorrhagia that interferes with their
normal activities
• Bleeding heavily and/or if periods last
more than seven days is considered
excessively heavy menstruation
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DUB
• Doctors generally define menorrhagia as
menstrual bleeding that lasts more than eight
to ten days or a blood loss of over 80
milliliters (about 1/3 cup). This would be
considered dysfunctional uterine bleeding
(DUB), and could lead to an iron deficiency or
anemia if not attended to promptly
DUB Variations
• Blood tests
• Pap test
• Endometrial sampling
and hysteroscopy
• Vaginal ultrasound
• Sonohysterogram
• Endometrial biopsy
• Dilatation and
curettage (D&C)
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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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Treatment
Specific treatment for menorrhagia is based on a
number of factors including:
• Overall health and medical history
• Extent of the condition
• Cause of the condition
• Tolerance for specific medications, procedures
or therapies
• Expectations for how the condition will progress
• Effects of the condition on the lifestyle
• Personal preference
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Drug therapy
Drug therapy for menorrhagia may include:
Others include:
• Iron supplements
• Prostaglandin inhibitors
• Oral contraceptives
• Progesterone
Protocol for Management
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Surgical Options
• Dilation and
curettage (D and C)
• Operative
hysteroscopy
• Endometrial ablation
• Endometrial
resection
• Hysterectomy
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Abdominal Hysterectomy Vs Endometrial Resection
Abdominal hysterectomy vs. endometrial resection
• .Abdominal hysterectomy requires longer theatre times and hospital stay, whereas
resection (ablation) is a day-stay or overnight procedure.
• Abdominal hysterectomy has a higher complication rate (45%) compared with
transcervical endometrial resection (0-15%)
• Reported mortality rates for abdominal hysterectomy are two to five times higher
than those for endometrial resection, and major complication rates are five to twelve
times .
• Resumption of normal activities after abdominal hysterectomy takes two to three
months versus two to three weeks for resection.
• The probability of requiring a hysterectomy four years after endometrial resection has
been estimated to be 12%.
• Hysterectomy is preferable if the patient has a large uterus, severe endometriosis
• Endometrial resection/ablation avoids possible ovarian dysfunction and the
psychological effects of hysterectomy.
• Endometrial resection has a 47% cost advantage over hysterectomy because of
shorter theatre time and hospital stay, but the cost advantage diminishes with time to
29% because of the need for repeat surgery.
Hysterectomy
• Compared with abdominal hysterectomy, vaginal hysterectomy is associated with
less pain and morbidity, shorter hospital stays and faster recovery periods.
• Laparoscopic hysterectomy results compared with abdominal hysterectomy,
postoperative pain is reduced and hospital stays (one to four days) and recovery
periods (one to four weeks) are shorter
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Conclusion