Diagnosis and treatment of menorrhagia

Abstract

One-third of all women experience heavy menstrual bleeding at some point in their life. In western countries, about 5% of women of reproductive age will seek help for menorrhagia annually. Half of all women who consult for hypermenorrhea have some uterine abnormality, most often fibroids (among patients under 40 years of age) and endometrial polyps (above 40 years of age). Appropriate treatment considerably improves the quality of life of these patients, and it is important to make a rigorous assessment of the patient to provide the best treatment options. This guideline provides instructions on how to examine and treat women of fertile age who have menorrhagia. The subject's own assessment of the amount of menstrual blood loss does not generally reflect the true amount. All patients should undergo a pelvic examination and, if the menstrual pattern has changed substantially or if anaemia is present, a vaginal sonography should be carried out as the most important supplemental examination. Vaginal sonography combined with an endometrial biopsy is a reliable method for diagnosing endometrial hyperplasia or carcinoma, but it is insufficient for diagnosing endometrial polyps and fibroids; these can be diagnosed more reliably by sonohysterography or hysteroscopy. Non-steroidal anti-inflammatory drugs and tranexamic acid reduce menstrual blood loss by 20-60%, and the effectiveness of a hormonal intrauterine system (IUS) is comparable with that of endometrial ablation or hysterectomy. Cyclic progestogens do not significantly reduce menstrual bleeding of women who ovulate. Treatment should be started with one of the drug therapies, i.e. the IUS, tranexamic acid, anti-inflammatory drugs, or oral contraceptive. Drug treatment should be used and evaluated before surgical interventions are considered. With an effective training and feedback system, it is possible to organise the diagnostics, medical treatment and follow-up of heavy menstrual bleeding in the primary health care setting or in outpatient clinics, which reduces the burden on specialist health care.

A comparative study of tranexamic acid and ethamsylate in menorrhagia

“…[3][4][5][6] Nonsteroidal antiinflammatory drugs, hormonal treatment and surgical procedures can effectively reduce menstrual blood loss; however, variable efficacy, relative contraindications, potential adverse effects, or undesired effects on fertility can limit the use of these therapies. 7 Most patients complaining of menorrhagia have no detectable pelvic disease and are diagnosed as cases of dysfunctional uterine bleeding. The mechanisms controlling menstrual bleeding are poorly understood.…”

Gausus Menstruacinis Kraujavimas Reprodukciniu Moters Gyvenimo Laikotarpiu: Kaip Išvengti Gimdos Pašalinimo Operacijos

“…Tai toks menstruacinio kraujo kiekio netekimas, kuris pablogina moters fizinę, emocinę, socialinę teorija ir praktika 2014 -T. 20 (Nr. 4) bei materialinę gyvenimo kokybę ir/arba sukelia anemijai būdingus simptomus [3]. Atlikti tyrimai rodo, kad iki 51,6 proc.…”

“…Per metus Jungtinėse Amerikos Valstijose (JAV) ir Europos Sąjungos šalyse tik 5 proc. visų reprodukcinio amžiaus moterų, kurias vargina gausios mėnesinės, kreipiasi į gydytojus [3,4]. Net 67 proc.…”

Heavy menstrual bleeding: modern approach to problem solution

“…Считается, что в среднем 1 / 3 женщин страдают ОМК в течение отдельных периодов своей жизни [7,8]. Распространенность ОМК зависит от того, каким образом она определена [9].…”

“…• стиль жизни: курение, избыточная масса тела и употребление алкоголя увеличивают риск ОМК [1,7,14].…”