A menstrual bleeding disorder.

1. PREPARED BY MONONITA BHATTACHARJEE
MSC. NURSING (MEDICAL SURGICAL NURSING)
A bleeding disorder…
MENORRHAGIA

2. MENORRHAGIA
Menorrhagia is the medical term for
menstrual periods with abnormally
heavy or prolonged bleeding.
Menstrual flow more than >80 ml / cycle.

3. ITIOLOGY
 Hormone imbalance.
 Dysfunction of the ovaries.
 Uterine fibroids.
 Polyps.
 Adenomyosis.
 Intrauterine device (IUD).

4. CONTINUE….
 Pregnancy complications.
 Cancer.
 Inherited bleeding disorders.
 Medications.
 Other medical conditions

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 (anovulation),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.

6. 4. Uterine fibroids. These noncancerous (benign) tumors of the uterus
which may also induce menorrhagia.
5. Polyps. Small, benign polyps may cause heavy or prolonged menstrual
bleeding.
6. Adenomyosis. often causing heavy bleeding and painful menses.
7. Intrauterine device (IUD). Menorrhagia is a well-known side effect of
using a nonhormonal intrauterine.

7. 4. Pregnancy complications. miscarriage ,ectopic
pregnancy
5. Cancer. Rarely, uterine cancer, ovarian cancer and
cervical cancer
6. Inherited bleeding disorders.Von Willebrand's
disease
7. Medications. anti-inflammatory medications and
anticoagulants.
8. Other medical conditions. including pelvic
inflammatory disease (PID), thyroid problems,
endometriosis, and liver or kidney disease, may be
associated with menorrhagia.

8. SIGNS & SYMPTOMS
 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.

9. CONTINUATION….
 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,
fatigue or shortness of breath

10. 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.

11. RISK FACTORS
 Adolescent girls who have recently started menstruating.Girls 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.

12. 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).

13. 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. is the removal of a small piece of tissue from
the endometrium (the lining of the uterus).

14. PAP TEST

15. ENDOMETRIAL BIOPSY

16.  Ultrasound scan. To rule out any abnormality in uterus.
 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.

17. ULTRASOUND SCAN

18. SONOHYSTEROGRAM

19. HYSTEROSCOPY

20. TREATMENTS AND DRUGS
 Iron supplements If have iron deficiency anemia, recommend iron
supplements regularly.
 Nonsteroidal anti-inflammatory drugs NSAIDs, such as ibuprofen or
naproxen (Aleve), help reduce menstrual blood loss. NSAIDs have the
added benefit of relieving painful menstrual cramps (dysmenorrhea).

21. CONT…
 Tranexamic acid is an antifibrinolytic. It works by
preventing blood clots from breaking down too
quickly. This helps to reduce excessive bleeding.
 Combined oral contraceptives stabilize the
endometrium and thereby reduce the incidence of
breakthrough bleeding, it helps toregulate menstrual
cycles and reduce episodes of excessive or
prolonged menstrual bleeding.

22. CONT…
 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 cramps.

23. SURGICAL TREATMENT
 Dilation and curettage (D&C).refers to the dilation(widening/opening)
of the cervix and surgical removal of part of the lining of the uterus
and/or contents of the uterus by scraping and scooping (curettage).
 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.

24. DILATION AND CURETTAGE (D&C).

25. UTERINE ARTERY EMBOLIZATION

26. CONT…
 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.

27. FOCUSED ULTRASOUND ABLATION

28. CONT…
 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.
 Myomectomy. surgical removal of uterine fibroids.

29. ENDOMETRIAL RESECTION

30. MYOMECTOMY

31. CONT…
 Endometrial ablation. permanently destroying the
lining of uterus (endometrium).
 Hysterectomy. Hysterectomy — surgery to remove
your uterus and cervix — is a permanent procedure
that causes sterility and ends menstrual periods.

32. ENDOMETRIAL ABLATION

33. HYSTERECTOMY

34. THANK YOU