Menorrhagia and Metrorrhagia

Study Notes

Menorrhagia is excessive bleeding during menstruation, characterized by increased duration (over 7 days) and/or amount (over 80 mL).
Potential causes of menorrhagia include uterine growths or tumors, uterine cancer, hormonal imbalance, pelvic inflammatory disease, certain medications (e.g., aspirin), and coagulation disorders.
In younger women, menorrhagia is often linked to hormonal or endocrine issues, while in older women, it typically suggests inflammatory conditions or uterine tumors.
Uterine fibroids (leiomyomas) and endometrial polyps frequently cause menorrhagia in women in their 30s and 40s.
Emotional or psychological factors can also influence uterine bleeding.
The severity of menorrhagia is gauged by the number of pads or tampons used beyond what's typical for regular menstruation.
Metrorrhagia is uterine bleeding that occurs between menstrual periods or after menopause.
Metrorrhagia requires prompt diagnosis and treatment, as it could indicate cancer or benign tumors in the uterus and ovaries.
Endometrial cancer should be suspected in postmenopausal women experiencing spotting.
Diagnosis starts with a thorough health history and symptom review, emphasizing past menstrual history, including period length and bleeding characteristics.
The age at menarche should be documented.
Medication history should cover oral contraceptive use and intake of prescription and over-the-counter drugs.
Review the patient’s obstetric history and sexual history, including partners, onset of regular sexual activity, and any past or present STIs.
Diagnostic assessment includes a Pap smear, speculum exam, and pelvic examination.
Lab tests involve blood work and might include thyroid function tests, hormone level assessments, pregnancy tests, and complete blood counts.
Endometrial biopsy and ultrasonography help diagnose gynecologic causes of menorrhagia and metrorrhagia.
Endometrial ablation, using laser or electrosurgical methods, has effectively treated menorrhagia in many patients.