What is heavy menstrual bleeding & its management according to the affected age? - Dr. B Ramesh скачать в хорошем качестве

What is heavy menstrual bleeding & its management according to the affected age? - Dr. B Ramesh

A normal woman will have menstrual cycle lasting for 2 to 3 days and she will have about 80mL of blood loss. If the blood loss exceeds 80mL or more than 100mL it is called heavy menstrual bleeding. In India it is the commonest cause of anaemia in women. It can affect any age group. If it affects younger age group we call it puberty menorrhagia. There are various causes for this. One important cause is haemophilia and polycystic ovarian disease. We need to treat these patient with haemostatic drugs and hormonal drugs. The commonest age group for menorrhagia is after the age of 40. The cause cannot be found out and the treatment can be medical treatment, hysteroscopy followed by D&C and uterus removal depending upon the response of the patient. Fibroid is a frequent cause for heavy menstrual bleeding in this age group also. Endometrial polyps are one of the important cause for heavy menstrual bleeding around the age group of 40 to 50. So removal of the polyp or fibroid can cure the heavy bleeding and at the same time the patient can opt for uterus removal at this age. Another important cause for heavy bleeding around the perimenopausal age group is the cervical cancer and the endometrial cancer. So we have to rule out in all the patients about 40 years the possibility of endometrial cancer. For this we do hysteroscopy and endometrial biopsy and make sure the patient don’t have malignancy. At this age group 40 to45 when there is no identifiable pathology and the patient is not responding to the medicine there is another treatment called endometrial ablation wherein only the inner layer of the uterus is cauterised and removed. There are various methods by which endometrial ablation can be done. It can be done with hysteroscopy, balloon ablation or various other methods. So heavy bleeding is an important cause for anaemia in India and we have to group the patient in adolescent, middle age patient and perimenopausal patient and individualise the treatment and the treatment could be medication or hysteroscopic treatment or removal of the uterus or hysterectomy.