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Summary
This article examines the causes of menorrhagia and outlines approaches to diagnosis and treatment. It includes a description of the normal menstrual cycle and the clotting cascade. The research findings suggest that inherited bleeding disorders account for many cases of menorrhagia.
Keywords
Bleeding disorders; Menorrhagia; Menstrual disorders
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Aims and intended learning outcomes
The aim of this article is to provide an overview of the causes of menorrhagia, the diagnosis of conditions that can result in menorrhagia and its management. Menorrhagia is defined as excessive menstrual flow. It is often associated with dysmenorrhoea (painful periods). Menstrual problems are common, a source of distress to individual women and a cause of sickness absence (Thomas and Ellertson 2000).
Menorrhagia is frequently caused by disorders of the menstrual cycle. This provides a description ot the normal menstrual cycle and the anatomy of the endometrium (inner lining of the uterus). In the past many women experiencing menorrhapa did not receive adequate explanation of their symptoms. However, many cases of abnormally heavy menstrual bleeding are now known to he caused by coagulation defects. A description of the normal clotting cascade and possible causes of bleeding problems more generally, including heavy menstrual loss, are therefore included. After reading this article you should be able to:
* Describe the physiology of the normal menstrual cycle.
* Identity the gynaecological causes of menorrhagia.
* Take the history of a woman presenting with heavy bleeding.
* Outline the events that take place when blood vessels are damaged and explain how abnormalities can result m bleeding problems, including menorrhagia.
* List the investigations routinely performed to treat mcnorrhagia.
* Provide an account of the treatment options available to women experiencing menorrhagia.
Introduction
Normal menstruation occurs every 21 to 35 days, and lasts two to seven days, with a loss of between 35-45ml of blood (Shernian and Korenman 1975). Menorrhagia is defined as menstrual loss of 80ml or more. It is a commonly experienced symptom. Five percent of...