Menorrhagia

Menorrhagia (hypermenorrhea) is an increase in the secretion of blood. The amount of blood lost is rarely determined, so the diagnosis is purely subjective. Of course, a woman who complains of blood clots during her period, who bleeds all over the supermarket floor every month, or who suffers from anemia, has lost a lot of blood, but in most cases the blood loss is small and only interferes with an active social life.

Causes of vaginal bleeding. The causes will likely vary among women of different ages. In young women, the most likely causes are pregnancy and uterine dysfunction. At an older age, you may want to consider an IUD, uterine fibroids, endometriosis and adenomyosis, pelvic infection, or polyps. During premenopause, consider endometrial carcinoma and hypothyroidism. Ask the patient about bleeding in general, as dyscrasia (a hemostasis disorder) may be present. Perform a pelvic examination, which may reveal polyps, uterine fibroids, or endometriosis.

Examination. May not be necessary. Check the blood picture, conduct a thyroid function test. If pelvic pathology is suspected, an ultrasound examination or laparoscopy should be performed. Women in the perimenopausal period need diagnostic curettage to exclude endometrial carcinoma.

To stop heavy endometrial bleeding, prescribe norethisterone at a dose of 5 mg every 8 hours orally.

Dysfunctional uterine bleeding. This is heavy, irregular bleeding associated with the anovulatory cycle and characteristic of the beginning and end of the reproductive period. If no pathological changes were detected during the gynecological examination and you have rejected the presence of organic disorders, this diagnosis can be made by exclusion.

Treatment for menorrhagia. It is necessary to pay attention to the underlying cause. In the presence of dysfunctional uterine bleeding, treatment depends on age. The patient should be convinced that she does not have an organ pathology. At a young age, menorrhagia can last until the establishment of regular menstruation and the appearance of ovulation. Too much bleeding can be the body's reaction to treatment - non-hormonal or hormonal. A woman with a full-fledged family may prefer a radical solution to the problem - hysterectomy or endometrial excision. Otherwise, she will have to wait for menopause.

First of all, you should try to prescribe non-hormonal drugs to the patient. They are taken during menstrual bleeding, they reduce blood loss. Try prescribing prostaglandin antagonists, for example, mefenamic acid at a dose of 500 mg every 8 hours orally after meals; contraindications: peptic ulcers. Antifibrinolytic drugs can be effective, for example, tranexamic acid at a dose of 1-1.5 g every 6-8 hours; contraindications: thromboembolism.

Hormonal therapy. Traditionally, cyclic prostaglandins are used, such as norethisterone at a dose of 5 mg every 8 hours orally either in the second half of the cycle - i.e. from the 19th to the 26th day, or, if there is no effect, during the entire cycle - i.e. from the 5th to the 26th day (after stopping the drug, the patient will have her period). The effectiveness of these drugs has not been proven in studies. Side effects: weight gain, breast tenderness, bloating. You can try prescribing combined oral contraceptive pills, but there are too many contraindications for the use of these drugs for elderly patients (and, as a rule, they are the ones who suffer from heavy bleeding). Danazol is effective at a dose of 100 mg every 6-24 hours orally (however, it is an expensive drug), but the patient may not be satisfied with the side effects: weight gain, acne, muscle pain, amenorrhea. The drug can suppress ovulation, but is not a reliable contraceptive.

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