Menorrhagia

*Def..
Menorrhagia is cyclical regular bleeding which is excee in amount or duration .
A normal menstrual alone loss is 50-80ml and does not exceed 100ml.
*Causes:
divided into 1.those due to some general condition
2. Those which are local  in pelvis
3. Those caused by endocrine disorder
4.contraceptive and
5. iatragenic.

1).those due to some general condition :-)
:a.blood dyscriasis like leukemia coagulopathy:,throncocytopenic purpura. Severe anemic.
B.Thyroid dysfunction :) hypo and hyper thyroid dysfunction
c.general TB may cause menorrhagia initially .
2.) Those which are local  in pelvis
a.:)uterine cause :) uterine fibroids. Fibroid polyps .adenomyosis
b.choclate cysts:) ovarian feminizing tumours.  PCOD endometriosis
c.)salphingo oophoritis pelvic inflammatory disease genital tb
d.) immediate puerpural and post abortal periods .

4.contraceptive:) IUCD is another factor causing 5-10% women suffering.

5. iatragenic.
Oestrogen and progesterone administration.

*INVESTIGATION
1.COMPLETE heomogram
2.bleeding time and clotting time
3.thyroid profile
4.pelvic sonography
5.diagnostic hystroscopy
6 .diagnostic laproscopy

*MANAGEMENT..
1 .general measure to improve the health status of the patient .
Advice regarding proper diet . Adequate rest .oral administration of haematinics vitamin and protein supplementation and to maintain menstrual calender moving duration and extent of alone loss.

2.treat the cause

for womens suffering from dysfunction menorrhagia
1.oral NSAID like mefenamic acid 500 mg tds along with antacid
other neporxane:ponstane
ibufrofen
2. Cyclical oral pill
3. Endomdtrial thermal ablation
4. Hysterctomy

For womens with obvious pathology
Therapeutic measures
1. Removal of an offending iucd
2. Myomectomy . Hysterectomy for uterine fibroids
3. Wedge resection for adenomyosis
4.laproscopic lysis of adhesion FOR CHRONIC PID
5. Electrocautery or laser vapourisatgnn of endometriosis  and drainage of chocolate cyst in pelvic endometriosis
6.hysterectomy with or without removal of the adnexa as per the age and individual need of the patient.