A Simple Guide to Menorrhagia2(Excessive Menstrual Bleeding)
--------------------------------------------------------------------------
What is a Menorrhagia?
--------------------------
Menorrhagia is a symptom defined as heavy, prolonged and/or irregular menstruation .
What are the causes of Menorrhagia?
-------------------------------------
1.Physiological(hormonal): most common
-----------------------------------
Excessive menstrual bleeding occurs when no ovulation takes place in a menstrual cycle with resultant excess oestrogen stimulation of the endometrium that results in the shedding of the thickened uterine lining and heavy bleeding when the oestrogen drops.
A defective persistent corpus luteum which results from an abnormal ovulation can also cause the shedding of the nedometrium for a longer period resulting in prolonged bleeding.
Other factors that may make heavy menstrual bleeding are:
2.Uterine Pathology:
-----------------------
polyps,
fibroids
endometriosis
infection
carcinoma
3.Systemic Diseases:
-----------------------
Bleeding diseases
Hypothyoidism
liver disease
Pelvic inflammatory Disease(PID)
Polycystic Ovarian syndrome(PCOS)
4.Medical causes:
--------------------
anticoagulants which are preventing clotting of blood
intrauterine device for contraception
How to establish a diagnosis of Menorrhagia?
---------------------------------------------
History:
--------------
Menstrual history:
cycle length, number of bleeding days, degree of blood loss(number of pads used per day), presence of blood clots, dysmenorrhea
Contraception:
use of IUD
contraceptive pills
Symptoms suggesting underlying pathology:
Metabolic disorders:
symptoms of hypothyroidism
symptoms of polycystic ovarian syndrome
Bleeding disorders:
easy bruising
anticoagulants
Pelvic inflammatory Disease:
pelvic pain especially during intercourse
vaginal discharge
dysmenorrhea
Endometriosis:
pelvic pain
dysmenorrhea
Physical Examination:
-----------------------------
Signs of underlying diseases:
bruising
hypothyroid features
pallour(anaemia)
PCOS features(hirsutism,acne,overweight)
Abdominal examination:
tenderness,
palpable uterine or ovarian masses
Pelvic examination:
vulval and vaginal examination
bimanual palpation for masses
cervical smear
Investigation:
------------------
Full blood count including hemoglobin(to exclude anemia from loss of blood) and platelets(low platelets can cause bleeding)
Transvaginal ultrasound to exclude uterine fibroids and polyps -postmenstrual scans is best when the endometrium is at its thinest.
Endometrial hysteroscopy and biopsy in women over 40 to exclude uterine cancer
What is the Treatment of Menorrhagia?
-------------------------------------------
Medications:
-------------
1.Tranexamic acid- oral antifibrinolytic, given only when there is heavy bleeding
2.Combined oral contraceptives - prevent proliferation of the endometrium, reduces blood flow. Side effects are fluid retention, nausea, headache,deep vein thrombosis, mood changes, breast tenderness
3.oral progesterone - also prevent proliferation of the endometrium-usually less side effects bloating, headache, mood changes, breast tenderness
4. Injected progesterone -also prevent proliferation of the endometrium -similar side effects as oral progesterone. One additional side effect is the possibility of bone density loss. Evaluation of bone density should be done.
5. Levonorgestrel-releasing intrauterine system(LNG-IUS)
-also prevent proliferation of the endometrium
-side effects includes irregular bleeding up to 6 month, amenorrhea(no menses),
breast tenderness, and headache.
Surgery
-------------
1.Endometrial ablation
may be done only
a.if medications has failed
b.if no desire to coceive
c.if the uterus is normal
Usually involve the removal of the endometrium through the cervical opening.
There are forms of endometrial ablation:
a.First generation:
hysteroscopy with general anaesthesia
-Rollerball ablation
-Transcervical resection of the endometrium
b.Second Generation:
non-hysteroscopy, no general anaethesia, day surgery,fast recovery
-Impedance-controlled bipolar radiofrequency ablation
-balloon thermal ablation
-microwave ablation
-free fluid thermal ablation
2. Hysterectomy
used only as a last resort in treatment of menorrhagia
if other treatment are contraindicated
there is a desire for amenorrhea
there is no desire to retain uterus and fertility
Treatment of Underlying causes:
----------------------------------
hypothyroidism with thyroxine tablets
intrauterine device removal
reduce anticoagulant treatment if possible
treat any bleeding disease with platelets or blood factor deficient infusion
treatment of endometriosis,
antibiotic treatment of pelvic inflammatory idsease
treatment of uterine carcinoma
surgical removal of fibroids and polyps
Showing posts with label PID. Show all posts
Showing posts with label PID. Show all posts
Sunday, June 29, 2008
Friday, November 23, 2007
A Simple Guide to Pelvic Inflammatory Disease
A Simple Guide to Pelvic Inflammatory Disease
--------------------------------------------------------
What is Pelvic Inflammatory Disease?
---------------------------------------------
Pelvic inflammatory disease (PID) is a general term used to describe inflammatory disorders of the upper female genital tract, such as infection of the uterus, fallopian tubes, ovaries and tissues around the reproductive organs.
These include endometritis, salpingitis, tubo-ovarian abscess, and pelvic peritonitis.
What is the cause of PID?
------------------------------
It is the result of infection from some sexually transmitted diseases especially chlamydia and gonorrhea.
The fallopian tubes and tissues in and near the uterus and ovaries are the most frequent organs damaged.
Sexually active women in their childbearing years are most likely to get PID.
Women under age 25 are more likely to develop PID than those older than 25.
The cervix of young women is not fully matured, and therefore more prone to be infected by STD.
Vaginal douching in women changes the vaginal bacteria flora in harmful ways, and can also force bacteria into the upper reproductive organs from the vagina.
Women with an intrauterine device (IUD) inserted has an increased risk of PID compared with women using other contraceptives or no contraceptive at all.
What are the signs and symptoms of PID?
--------------------------------------------------
Symptoms of PID can vary widely.
Women whose PID is caused by chlamydial infection may have mild symptoms or no symptoms at all even as serious damage is being done to her reproductive organs. Most cases of PID are not detected about two thirds of the time.
Common symptoms of PID are
1.lower abdominal pain
2.fever,
3.unusual vaginal discharge with a foul odor,
4.painful intercourse,
5.painful urination,
6.irregular menstrual bleeding, and
7.pain in the right upper abdomen (rare).
How is PID diagnosed?
---------------------------
Because the symptoms are often subtle and mild, most cases of PID go undetected.
Diagnosis is usually based on clinical findings:
1.lower abdominal pain
2.abnormal cervical or vaginal mucopurulent discharge
3.oral temperature >101°F (>38.3°C)
together with investigation findings
4.laboratory evidence of gonorrheal or chlamydial infection.
5.A wet specimen of vaginal fluid is able to detect the presence of concomitant infections ( bacterial vaginosis and trichomoniasis)
6. pelvic ultrasound is a helpful procedure for diagnosing PID.It can check the pelvic area to see whether there is an abscess or enlarged fallopian tubes.
7.laparoscopy is a minor surgical procedure in which a thin, flexible tube with a lighted end in inserted through a cut in the navel area to view the internal pelvic organs and to take specimens for testing.
Other criteria for diagnosing PID include the following:
8.endometrial biopsy with histopathologic evidence of endometritis;
9.transvaginal sonography or magnetic resonance imaging techniques showing thickened, fluid-filled tubes with or without free pelvic fluid or tubo-ovarian complex,
10.doppler studies suggesting pelvic infection
What are the complications of PID?
-----------------------------------------
Prompt and appropriate treatment can help prevent complications of PID.
Without treatment, PID can cause
1. permanent damage to the female reproductive organs.
Infection-causing bacteria can invade the fallopian tubes, damaging the lining of the tubes causing blockage of the fallopian tubes and preventing sperm from fertilising an egg.
2.Infertility also occur when the fallopian tubes are partially blocked or even slightly damaged as therm may find it difficult to reach the egg.
3.ectopic pregnancy may occur when the fertilized egg remains in the partially blocked fallopian tube and begins to grow.
As it grows, an ectopic pregnancy can cause rupture of the fallopian tube resulting in abdominal pain, internal bleeding, and death.
4.chronic pelvic pain that lasts for months or even years due to the inflammation, damage to the pelvic organs, and contraction of the scarred tissues.
5.endometrosis are blood clots in the pelvic region which occurs due to inflammation of the pelvis and can also cause pain during menses.
6. abscess formation in the reproductive organs or pelvis which can spread to the blood and cause septicemia.
What is the treatment for PID?
-------------------------------------
Treatment of PID should be initiated in
1.sexually active young women
2. pelvic or lower abdominal pain,
3. physical examination shows cervical motion tenderness, uterine tenderness or adnexal tenderness.
PID can be treated with several types of antibiotics(eg.clindamycin or metronidazole with doxycycline).
However, antibiotic treatment will not reverse any damage to the reproductive organs. If a woman has pelvic pain and other symptoms of PID, it is important that she seek care immediately.
Prompt antibiotic treatment can prevent severe damage to reproductive organs.
PID is usually treated with at least two antibiotics given by mouth or by injection.
Even if symptoms go away, the woman should finish taking all of the prescribed medicine.
This will help prevent the infection from returning.
Hospitalization to treat PID may be recommended if the woman
(1) is severely ill with nausea, vomiting, and high fever
(2) is pregnant;
(3) does not respond to or cannot take oral medication and needs intravenous antibiotics;
(4) has an abscess in the fallopian tube or ovary (tubo-ovarian abscess).
(5)surgical emergencies (e.g., appendicitis) cannot be excluded;
If symptoms continue or if an abscess does not go away, surgery may be needed.
Complications of PID such as chronic pelvic pain and scarring improve with surgery.
How can PID be prevented?
--------------------------------
1. transmission of STDs can be prevented by abstainance from sexual intercourse,
2. a long-term mutually monogamous relationship with a partner who has been tested and is known to be uninfected can prevent STD.
3.Latex male condoms, when used consistently and correctly, can reduce the transmission of chlamydia and gonorrhea.
4.chlamydia testing of all sexually active women age 25 or younger and of older women with risk factors for chlamydial infections especially those with a new sex partner or multiple sex partners
5.Any genital symptoms such as an unusual sore, discharge with odor, burning during urination, or bleeding between menstrual cycles suggests a STD infection. Early treatment of STDs can prevent PID.
6. Intrauterine contraceptive devices containing levonorgestrel-and copper-containing devices may cause PID and should be removed if antibiotics does not cure the PID.
--------------------------------------------------------
What is Pelvic Inflammatory Disease?
---------------------------------------------
Pelvic inflammatory disease (PID) is a general term used to describe inflammatory disorders of the upper female genital tract, such as infection of the uterus, fallopian tubes, ovaries and tissues around the reproductive organs.
These include endometritis, salpingitis, tubo-ovarian abscess, and pelvic peritonitis.
What is the cause of PID?
------------------------------
It is the result of infection from some sexually transmitted diseases especially chlamydia and gonorrhea.
The fallopian tubes and tissues in and near the uterus and ovaries are the most frequent organs damaged.
Sexually active women in their childbearing years are most likely to get PID.
Women under age 25 are more likely to develop PID than those older than 25.
The cervix of young women is not fully matured, and therefore more prone to be infected by STD.
Vaginal douching in women changes the vaginal bacteria flora in harmful ways, and can also force bacteria into the upper reproductive organs from the vagina.
Women with an intrauterine device (IUD) inserted has an increased risk of PID compared with women using other contraceptives or no contraceptive at all.
What are the signs and symptoms of PID?
--------------------------------------------------
Symptoms of PID can vary widely.
Women whose PID is caused by chlamydial infection may have mild symptoms or no symptoms at all even as serious damage is being done to her reproductive organs. Most cases of PID are not detected about two thirds of the time.
Common symptoms of PID are
1.lower abdominal pain
2.fever,
3.unusual vaginal discharge with a foul odor,
4.painful intercourse,
5.painful urination,
6.irregular menstrual bleeding, and
7.pain in the right upper abdomen (rare).
How is PID diagnosed?
---------------------------
Because the symptoms are often subtle and mild, most cases of PID go undetected.
Diagnosis is usually based on clinical findings:
1.lower abdominal pain
2.abnormal cervical or vaginal mucopurulent discharge
3.oral temperature >101°F (>38.3°C)
together with investigation findings
4.laboratory evidence of gonorrheal or chlamydial infection.
5.A wet specimen of vaginal fluid is able to detect the presence of concomitant infections ( bacterial vaginosis and trichomoniasis)
6. pelvic ultrasound is a helpful procedure for diagnosing PID.It can check the pelvic area to see whether there is an abscess or enlarged fallopian tubes.
7.laparoscopy is a minor surgical procedure in which a thin, flexible tube with a lighted end in inserted through a cut in the navel area to view the internal pelvic organs and to take specimens for testing.
Other criteria for diagnosing PID include the following:
8.endometrial biopsy with histopathologic evidence of endometritis;
9.transvaginal sonography or magnetic resonance imaging techniques showing thickened, fluid-filled tubes with or without free pelvic fluid or tubo-ovarian complex,
10.doppler studies suggesting pelvic infection
What are the complications of PID?
-----------------------------------------
Prompt and appropriate treatment can help prevent complications of PID.
Without treatment, PID can cause
1. permanent damage to the female reproductive organs.
Infection-causing bacteria can invade the fallopian tubes, damaging the lining of the tubes causing blockage of the fallopian tubes and preventing sperm from fertilising an egg.
2.Infertility also occur when the fallopian tubes are partially blocked or even slightly damaged as therm may find it difficult to reach the egg.
3.ectopic pregnancy may occur when the fertilized egg remains in the partially blocked fallopian tube and begins to grow.
As it grows, an ectopic pregnancy can cause rupture of the fallopian tube resulting in abdominal pain, internal bleeding, and death.
4.chronic pelvic pain that lasts for months or even years due to the inflammation, damage to the pelvic organs, and contraction of the scarred tissues.
5.endometrosis are blood clots in the pelvic region which occurs due to inflammation of the pelvis and can also cause pain during menses.
6. abscess formation in the reproductive organs or pelvis which can spread to the blood and cause septicemia.
What is the treatment for PID?
-------------------------------------
Treatment of PID should be initiated in
1.sexually active young women
2. pelvic or lower abdominal pain,
3. physical examination shows cervical motion tenderness, uterine tenderness or adnexal tenderness.
PID can be treated with several types of antibiotics(eg.clindamycin or metronidazole with doxycycline).
However, antibiotic treatment will not reverse any damage to the reproductive organs. If a woman has pelvic pain and other symptoms of PID, it is important that she seek care immediately.
Prompt antibiotic treatment can prevent severe damage to reproductive organs.
PID is usually treated with at least two antibiotics given by mouth or by injection.
Even if symptoms go away, the woman should finish taking all of the prescribed medicine.
This will help prevent the infection from returning.
Hospitalization to treat PID may be recommended if the woman
(1) is severely ill with nausea, vomiting, and high fever
(2) is pregnant;
(3) does not respond to or cannot take oral medication and needs intravenous antibiotics;
(4) has an abscess in the fallopian tube or ovary (tubo-ovarian abscess).
(5)surgical emergencies (e.g., appendicitis) cannot be excluded;
If symptoms continue or if an abscess does not go away, surgery may be needed.
Complications of PID such as chronic pelvic pain and scarring improve with surgery.
How can PID be prevented?
--------------------------------
1. transmission of STDs can be prevented by abstainance from sexual intercourse,
2. a long-term mutually monogamous relationship with a partner who has been tested and is known to be uninfected can prevent STD.
3.Latex male condoms, when used consistently and correctly, can reduce the transmission of chlamydia and gonorrhea.
4.chlamydia testing of all sexually active women age 25 or younger and of older women with risk factors for chlamydial infections especially those with a new sex partner or multiple sex partners
5.Any genital symptoms such as an unusual sore, discharge with odor, burning during urination, or bleeding between menstrual cycles suggests a STD infection. Early treatment of STDs can prevent PID.
6. Intrauterine contraceptive devices containing levonorgestrel-and copper-containing devices may cause PID and should be removed if antibiotics does not cure the PID.
Subscribe to:
Posts (Atom)
Subscribe Now: Feed Icon
Click and bookmark these Social Networking Bookmarks
