Published on Jun 07, 2018 and last reviewed on Jun 10, 2022 - 5 min read
Abstract
Heavy and unscheduled menstrual bleeding can affect the quality of a woman's life and affect her physically and emotionally. Learn about the common causes and treatment options for severe, painful, and irregular menstrual bleeding.
Introduction:
Menstrual bleeding affects the quality of a woman's life and impacts her physically, emotionally, and socially, with or without mild to severe signs and symptoms, and it needs attention. Mostly longer, anovulatory cycles have been observed at and after puberty, whereas frequent and short interval cycles are seen in older women.
Menorrhagia is the cause of around 20 % of gynecologist referrals to hospitals where one in 20 ladies of reproductive age consults a GP (general practitioner) with heavy bleeding. 20 % of ladies have a hysterectomy (removal of the uterus) before 60 years of age due to heavy bleeding.
If periods are unacceptably heavy with or without symptoms, that is, there may or may not be clotting and flooding (not necessarily more significant than 80 ml per cycle), then they need investigations and treatment to prevent further complications like anemia, endometrial hyperplasia, and endometrial cancer.
Pain during menses (dysmenorrhea) is unacceptable, mainly in the first two days of bleeding. The following are the causes of dysmenorrhea,
Idiopathic: It occurs mainly in teenage girls, mostly in ovulatory cycles. It might be due to oversensitivity to prostaglandins and overproduction of inflammatory mediators, their local side effects, genetic, psychological causes, or neuropathic dysregulation.
Secondary: It is due to an underlying cause or pathology. It could be fibroids, intrauterine contraceptive devices, cervical or uterine pathology, pelvic inflammatory disease, previous surgery (with or without postoperative adhesion), endometriosis, adenomyosis, congenital pelvic abnormalities, Asherman syndrome, etc.
A detailed history (gynecological, medical, drug, obstetrical, hormonal, contraceptive, or drug intake).
Examination (generalized and local) - Sometimes, hysteroscopic and laparoscopic tests help a lot to exclude pathologies.
A complete blood count is a preliminary test to check for anemia and platelet count.
Thyroid function test.
Coagulation profile only indicated if having a history or symptoms.
Sexually transmitted disease screening in case of a history of infection only.
Transvaginal scan for endometrial thickness, polyp, fibroid, endometriosis, congenital abnormalities, or other local pathology.
Endometrial biopsy is taken in women aged 40 years with irregular, continuous, heavy, unscheduled, or erratic menses. The biopsy could be a Pipelle endometrial biopsy or hysteroscopic biopsy.
Laparoscopy is advised for women with severe, unbearable, painful periods with abnormal ultrasound findings, medical treatment failure, or along with suspected infertility.
For managing any of the conditions mentioned above, the patient's wish and convenience are crucial. Following are the treatment modalities:
A. Medical Treatments:
B. Surgical Treatments:
If the patient does not respond to medical treatment, surgical treatment options are advised.
Conclusion:
In short, heavy, irregular, unscheduled painful vaginal bleeding needs to be investigated and treated according to the patient's need, wish, and convenience to improve the quality of life and to prevent long-term consequences like endometrial cancer.
For more information, consult a menstrual disorders specialist online --> https://www.icliniq.com/ask-a-doctor-online/obstetrician-and-gynaecologist/menstrual-disorders
Last reviewed at:
10 Jun 2022 - 5 min read
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Obstetrics And Gynaecology
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