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Mohd Helmy B Abu Bakar
012010050487
Year 4 MBBS-MSU
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Disorders of menstrual cycleTopic covered:
1. Menorrhagia
2. Dysmenorrhea
3. Amenorrhea/oligomenorrhea
4. Polycystic ovarian syndrome
5. Post menopausal bleeding6. Premenstrual syndrome
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Menorrhagia/Heavy menstrual
bleeding
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Definition
Menorrhagia can be defined as a complaint of
heavy cyclical menstrual blood loss over
several consecutive menstrual cycles in a
woman of reproductive years, or more
objectively, a total menstrual blood loss of
more than 80 ml per menstruation
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Prevalence
Extremely common
5% of women within the ages of 30 and 49
years old
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Atielogy
Fibroids
Endometrial polyps
Coagulation disorders eg: von Willebrands
disease Pelvic inflammatory disease (PID)
Thyroid disease
Drug therapy eg: warfarin
Intrauterine contraceptive devices (IUCDs)
Endometrial/ cervical carcinoma
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Uterus fibroid
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Endometrial polyp
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Clinical features
History
Hallmark of menorrhagia is complaint of regularexcessive menstrual loss over several consecutive
cycles Discussion of the numbers of the towels and
tampons used per day (menstrual pictogram)
Impact of the condition on the patients lifestyle
and quality of life (severity) Duration of current problem and any other
symptoms
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Other symptoms :
Irregular
Intermenstrual or post coital bleeding
Change in symptoms
Dyspareunia
Pelvic or premenstrual pain
Excessive bleeding from other sites eg: aftertooth extraction
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Clinical examination
Sign of anemia, obesity, thyroid
Abdominal and pelvic examination Swabs and cervical smears
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Investigation
1. FBC
2. Coagulation screen
3. Pelvic ultrasound Pelvic mass palpated
Symptoms suggest endometrial polyps
Drug therapy failed
4. Endometrial biopsy (pipelle) Aged > 45 years
Irregular or intermenstrual bleeding
Drug therapy failed
5. Thyroid function test Only performed when the history is suggestive of a thyroid disease
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Pipelle endometrial sampler
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Management
When selecting appropriate management for thepatient, it is important to consider and discuss:
The patients preference of treatment
risk/benefits of each option Contraceptive requirements:
Family complete?
Current contraception?
Past medical history:
Any contraindication to medical therapies
Suitability for an anesthetic
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Medical treatment
1. Mefenamic acid and NSAIDS (500mg p.o tds)Advantages: effective anegesia 1st line treatmentwhen dysmenorrhea coexist
Disadvantages: contraindicated for duodenal ulcer
or severe asthma2. Tranexamic acid (1g p.o qds)
3. Combined oral contraceptive pill (COCP)
Advantages: doubles up as a very effective when
taken properlyDisadvantages: contraindicated for
thromboembolism, ages > 35 who smokes, breastcancer, grossly overweight
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4. Norethisterone (5-10mg tds on day 6-26)
5. Levonogastrel intrauterine system (LNG-IUS)
6. GnRH agonist:
Gasorelin 3.6mg monthly subcutaneous
implant
Decapeptyl 3mg monthly s/c or im
Buserelin 300g nasal spray tds
7. Danazol
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LNG-IUS/mirena
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Surgical management
1. Endometrial ablation
2. Hysteroscopic resection polyp / fibroid
3. Hysterectomy
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Endometrial ablation
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Endometrial ablation
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Fibroid resection
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Complications
Excessive or prolonged menstrual bleeding can
lead to other medical conditions, including:
Severe pain
Infertility
Toxic shock syndrome
Anemia
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Thank you