Menorrhagia

Description

Menorrhagia is defined as excessive amount or duration of menstrual flow, at more or less regular intervals. The average normal menstrual flow is about 30 mL per cycle. Abnormal bleeding is common, about 50% of cases occur after 40 years of age.

Dysfunctional bleeding is fairly common in adolescence and near menopause.

Menorrhagia is distinguished from, but may overlap with, Metrorrhagia (irregular or frequent flow, noncyclic), Menometrorrhagia (frequent, excessive, irregular flow; menorrhagia plus metrorrhagia), Polymenorrhea (frequent flow, cycles of 21 days or less), Intermenstrual bleeding (bleeding between regular menses), and Dysfunctional uterine bleeding - DUB (abnormal endometrial bleeding of hormonal cause and related to anovulation).

Causes

Causes of menorrhagia include: Hypothyroidism; Endometrial proliferation/excess/hyperplasia: Anovulation, oligo-ovulation, Polycystic ovarian disease (PCOD), Stein-Leventhal syndrome, Ovarian tumor, Obesity, Hormone (estrogen) therapy; Endometrial atrophy: Postmenopausal, Prolonged progestin or oral contraceptive administration; Local factors: Endometrial polyps, Endometrial neoplasia, Adenomyosis/endometriosis, Uterine myomata (fibroids), Intrauterine device (IUD), Uterine sarcoma; Coagulation disorders: Thrombocytopenia, platelet disorders, von Willebrand's disease, Leukemia, Ingestion of aspirin or anticoagulants, Renal failure/dialysis.

Risk factors include: Obesity, Anovulation, Estrogen administration (without progestin), Prior treatment with progestational agents or oral contraceptives increases the risk of endometrial atrophy, but decreases the risk of endometrial hyperplasia or neoplasia

Conventional Labs

Conventional lab tests include: a Pregnancy test and CBC to assess severity of blood loss, and exclude thrombocytopenia and leukemia.

In selected cases: TSH - elevated in hypothyroidism; Platelet count, bleeding time, prothrombin time (PT), partial thromboplastin time (PTT) for coagulation screen; Creatinine, BUN; Serum progesterone.

Specialty Lab Tests

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