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Menorrhagia - is hysterectomy the answer?
Part
I
 The answer is a big no. The incidence of hysterectomy (surgical removal of uterus) has increased. But there is a definite place for medical management for heavy bleeding. Hysterectomy is not the first line of management.
A normal menstrual blood loss does not exceed 100 ml & the cycle is once in 28 -35 days & the bleeding lasts for 4-5 days.
What is Menorrhagia?
The cycle is unaltered but the duration & quantity of the menstrual loss are increased. Menorrhagia is essentially a symptom and not a disease. The underlying cause may be difficult to detect. The causes may be:
1. Due to a general disease
2. Due to local pelvic causes
3. Caused by endocrine disorders
4. Contraceptives
5. Iatrogenic
General diseases causing menorrhagia:
1. Genital tuberculosis.
.
The incidences of tuberculosis amongst women are as follows:
Infertility-------2-10%
Puberty menorrhagia --------4%
Tuberculosis causes initial menorrhagia, but in advanced stage amenorrhoea ensues.
2. Thyroid disorders:
Hypothyroidism (low functioning) & hyperthyroidism (excess secretion) . In both the conditions the initial response is menorrhagia.
3. Blood dyscrasias:
Leukaemia, severe anemia, coagulopathies.
Local causes:
1. Uterine fibroid, fibroid polyp.
2. Chocolate cysts of ovaries, endometriosis, adenomyosis, Pcod, Feminizing ovarian tumours.
3. Pelvic inflammatory diseases, Salpingo oophorities, genital T.B.
4. Post abortal & puerperal menorrhagia.
The intra-uterine contraceptive devices: 5-10% of women suffer in the first few months. Post sterilization menorrhagia is reported in about 12-15%.
`In a large number of patients we may not encounter any of the above mentioned
disorders. These women are diagnosed to have Dysfunctional Bleeding (DUB).
The aetiology is purely hormonal & associated with endometrial hyperplasia, hypertrophy , hyper estrogenism.
DUB is classified into anovlatory & ovulatory bleeding .This helps us to understand the underlying pathology and thereby the management.
Anovlatory Ovulatory
Puberty menorrghagia Irregular ripening
Metropathia heamorrhagica Irregular shedding
Premenopausal DUB Iucd
Post sterilization
(to be continued)
For further details contact:
Dr.T.Mangaiyarkarasi .M.D: D.G.O
Sivanandham Clinic,
No. 3, 94th Street, 21st Avenue,
Ashok Nagar, Chennai 600083.
Phone nos: 4815253 / 4801444.
E-mail id: Sivanu@md3.vsnl.in.net
Published on
20th October, 2002
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