Practice diagnosis and treatment of menorrhagia

2021-03-25 12:00 AM

Examination of the pelvic area for pathological causes, such as ovarian or uterine tumours... You can perform a pelvic ultrasound if needed.

Menopause is an abnormally heavy vaginal bleeding that occurs during menstruation, usually over 90ml, compared with the normal average of about 60ml. It should be distinguished from multiple menstruation is a condition that shortens the menstrual cycle, causing the patient to have more periods than normal people. If the bleeding is large but regular, it is rarely associated with a pelvic pathology.

Reason

Due to an imbalance between the hormones that control the menstrual cycle, oestrogen and progesterone, the lining of the uterus becomes too thick, and thus more blood is shed.

Menorrhagia can also be caused by a number of uterine diseases such as uterine fibroids, polyps, pelvic inflammatory diseases ...

In some cases, it is caused by using a contraceptive device placed in the uterus.

Diagnose

Determine how much blood is spotting during each period.

Regular bleeding or unusual signs, with or without blood clots.

Understand the symptoms of anemia.

Determination of haemoglobin concentration.

Examination of the pelvic area for pathological causes, such as ovarian or uterine tumors ... Pelvic ultrasound if needed.

Follicle-stimulating hormone (FSH) test if suspected is menopause.

Women under 40 years of age with menorrhagia are less likely to be associated with physical disease. If you are a woman over 40 years old, you need to examine carefully to detect the physical diseases.

If menorrhagia has a sudden onset, specialist referral should be considered immediately.

Treatment

If you are using an intrauterine device, please remove it and consider replacing it with another method of contraception.

Instruct the patient to record complete information about each menstrual period.

Use mefenamic acid 250 - 500mg, 3 times a day.

Only use during menstruation, on a few days when the most bleeding occurs.

If there is a need for contraception, the use of combined oral contraceptives with high levels of progesterone may be effective.

Progestogens, such as norethisterone 5-10mg 2 times a day, from day 19 to day 26 of the menstrual cycle. If your menstrual cycle is shortened, start this 8-day course about 10 days before your period. The reasons for the use of progestogen are not well understood.

To control excessive bleeding, administer norethisterone up to 10mg, 3 times a day. Usually, the bleeding stops after 48 hours. Then, reduce the dose to 5mg, 2 times a day, for 12 consecutive days. Often patients can bleed when the drug is stopped.

In some cases, the use of:

Fibrinolytic drugs, such as aminocaproic acid, 1-2 sachets, 4 times a day, or ethamsylate 500mg, 4 times a day during menstruation. For short-term use only.

Danazol 200mg daily for 3 consecutive months.

Very common side effects.

When a patient appears to be unresponsive to treatment, consider a referral to a specialist, which may require surgical removal of the endometrium of the uterus.