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  1. 1. Menorrhagia Menorrhagia is defined as excessive menstrual blood loss which interferes with a woman's physical, social, emotional and/ or material quality of life. It can occur alone or in combination with other symptoms. (rwcE Guidance 2016).
  2. 2. Symptoms The signs and symptoms of menorrhagia may include: Soaking through one or more sanitary pads or tampons every hour for several consecutive hours Needing to use double sanitary protection to control your menstrual flow Needing to wake up to change sanitary protection during the night Bleeding for longer than a week Passing blood clots with menstrual flow for more than one day Restricting daily activities due to heavy menstrual flow Symptoms of anemia, such as tiredness, fatg or shortness of breath
  3. 3. When to see a doctor Vaginal bleeding so heavy it soaks at least one pad or tampon an hour for more than a few hours Bleeding between periods or irregular vaginal bleeding Any vaginal bleeding after menopause
  4. 4. Causes Hormone imbalance. Dysfunction of the ovaries. Uterine fibroids. Polyps. Adenomyosis. Intrauterine device (IUD). Pregnancy complications. Cancen 9. Inherited bleeding disorders. 10. Medications. 11. Other medical conditions. 9°. “.°". °‘. "‘. °°. "’. "
  5. 5. 1. Hormone imbalance. If a hormone imbalance occurs between the hormones estrogen and progesterone, the endometrium develops in excess and eventually sheds by way of heavy menstrual bleeding. 2. Dysfunction of the ovaries. If ovaries don't ovulate during a menstrual cycle (anovu| ation), body doesn't produce the hormone progesterone, as it would during a normal menstrual cycle. This leads to hormone imbalance and may result in menorrhagia. 3. Uterine fibroids. These noncancerous (benign) tumors of the uterus appear during childbearing years.
  6. 6. 4. 10. 11. Polyps. Small, benign polyps may cause heavy or prolonged menstrual bleeding. Adenomyosis. often causing heavy bleeding and painful menses. Intrauterine device (IUD). Menorrhagia is a well- known side effect of using a nonhormonal intrauterine. Pregnancy complications. miscarriage , ectopic pregnancy Cancer. Rarely, uterine cancer, ovarian cancer and cervical cancer Inherited bleeding disorders. Von Willebrand's disease Medications. anti-inflammatory medications and anticoagulants. Other medical conditions. including pelvic inflammatory disease (PID), thyroid problems endometriosis, and liver or kidney disease, may be associated with menorrhagia.
  7. 7. Risk factors Adolescent girls who have recently started menstruating. Gir| s are especially prone to anovulatory cycles in the first year after their first menstrual period (menarche). Older women approaching menopause. Women ages 40 to 50 are at increased risk of hormonal changes that lead to anovulatory cycles.
  8. 8. Complications A. Iron deficiency anemia. Menorrhagia may decrease iron levels enough to increase the risk of iron deficiency anemia. B. Severe pain. with heavy menstrual bleeding, you might have painful menstrual cramps (dysmenorrhea).
  9. 9. Tests and diagnosis Blood tests. evaluate for iron deficiency (anemia) and other conditions, such as thyroid disorders or blood-clotting abnormalities. Pap test. cells from cervix are collected and tested for infection, inflammation or cancerous changes. Endometrial biopsy. Ultrasound scan. For uterus, ovaries and pelvis.
  10. 10. « Sonohysterogram. During this test, a fluid is injected through a tube into uterus by way of vagina and cervix. using ultrasound to look for problems in the lining of uterus. ~/ Hysteroscopy. This exam involves inserting a tiny camera through vagina and cervix into uterus, which allows to see the inside of uterus.
  11. 11. Treatments and drugs « Iron supplements. If have anemia, recommend iron supplements regularly. « Nonsteroidal anti-inflammatory drugs. NSA| Ds, such as ibuprofen or naproxen (Aleve), help reduce menstrual blood loss. NSA| Ds have the added benefit of relieving painful menstrual cramps (dysmenorrhea). « Tranexamic acid. Tranexamic acid helps reduce menstrual blood loss.
  12. 12. « Oral contraceptives. oral contraceptives can help regulate menstrual cycles and reduce episodes of excessive or prolonged menstrual bleeding. « Oral progesterone. the hormone progesterone can help correct hormone imbalance and reduce menorrhagia. « The hormonal IUD (Mirena). This releases a type of progestin called levonorgestrel, which makes the uterine lining thin and decreases menstrual blood flow and cramping.
  13. 13. Surgical Treatment ‘.1 Dilation and curettage (D&C). _I Uterine artery embolization. menorrhagia caused by fibroids, the goal is to shrink any fibroids in the uterus by blocking the uterine arteries and cutting off their blood supply. :1 Focused ultrasound ablation. Similar to uterine artery embolization, focused ultrasound ablation treats bleeding caused by fibroids by shrinking the fibroids. This procedure uses ultrasound waves to destroy the fibroid tissue. no incisions required for this procedure.
  14. 14. Myomectomy. surgical removal of uterine fibroids. Endometrial ablation. permanently destroying the lining of uterus (endometrium). Endometrial resection. This surgical procedure uses an electrosurgical wire loop to remove the lining of the uterus. Both endometrial ablation and endometrial resection benefit women who have very heavy menstrual bleeding. Pregnancy isn't recommended after this procedure. Hysterectomy. Hysterectomy — surgery to remove your uterus and cervix — is a permanent procedure that causes sterility and ends menstrual periods.
  15. 15. Thank You 4