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Menorrhagia

Menorrhagia refers to excessive loss of blood during menstruation. Many pre-menopausal women experience menorrhagia as a response to erratic hormonal activity. The endometrium may develop in excess due to hormonal imbalance and lead to heavy menstrual bleeding. Uterine polyps can lead to cases of menorrhagia. Polyps occur due to excessive hormone production or consumption.


Uterine fibroids or tumors can trigger off heavier than normal menstrual bleeding or prolonged menstrual bleeding. Women suffering from pelvic Inflammatory disease, thyroid problems and liver or kidney disease are also likely to notice excessive bleeding. In rare cases, menorrhagia is caused due to deficiency of vitamin K. Women who use IUD for birth control are likely to face excessive menstrual bleeding. Cancers of the female reproductive organs such as cervix cancer, ovarian cancer and uterine cancer cause excessive bleeding.


Tranexamic acid tablets are often prescribed to reduce excessive blood loss during menstruation. It is taken at the beginning of the period and does not stop menstrual bleeding. Tranexamic acid is not a contraceptive. It works on helping the blood in the uterus to clot. Often it is combined with an NSAID. Possible side effects include indigestion, diarrhea, headache and back pain. If the patient has a history of blood clots, tranexamic acid might not be advised.


Endometrial sampling is taken to check for cause of menorrhagia. Hysteroscopy and vaginal ultrasound aids in clinical diagnosis. Once the cause for excessive bleeding is identified, treatment is undertaken accordingly. Thyroid malfunction is treated with medication or birth control pills. Hysterectomy is performed for women who suffer prolonged heavy menstrual bleeding.

Galactorrhea

Also known as hyperlactation, galactorrhea is a rare condition wherein a grayish or white liquid is discharged from the breast. Galactorrhea by itself is not a disease, but it surely is a sign of an underlying problem like hormonal imbalance, tumor, etc. Any fluid discharge from the breast after menopausal stage in women could indicate breast cancer. However, the discharge related with breast cancer will be from one breast only. In galactorrhea, generally both breasts are involved. Presence of blood in the fluid discharged from the breast could be indicative of a benign growth in the breast tissue itself.


Galactorrhea cause


  • Birth control pills
  • Hypothyroidism
  • A non-cancerous pituitary tumor or any other disorder of the pituitary gland
  • Medications like antidepressants, few tranquilizers, high blood pressure drugs and hormonal supplements
  • Chronic kidney disease
  • Spinal cord surgery or tumor


Galactorrhea symptoms

  • Persistent or sporadic milky type of discharge, the discharge has no blood
  • Unexpected milk leak or manually expressed nipple discharge
  • One or both breasts get affected
  • Irregular menstrual periods or no menstrual periods
  • Headaches and/or vision problems
  • Acne
  • Increased hair growth on chin or chest

Diagnostic tools such as ultrasound, mammography and MRI to check for tumor are used.


Endometrial Ablation

Heavy menstrual bleeding may happen due to underlying conditions such as hormonal imbalance, uterine polyps and ovarian dysfunction. Menorrhagia is also an inherited disorder as it is associated with blood clotting impairments like Von willebrand's disease. In most cases, endometrial biopsies are done to determine histological overview of the conditions. Many treatment options are suggested depending upon the age, lifestyle and medical history of the patient. Among many prophylactic measures, endometrial ablation or uterus ablation is increasingly becoming the most preferred method.


The inner layer of the uterus called as the endometrium is removed using the diathermy electrode. The patient is subjected to general anesthesia during the procedure. Careful examination of the uterine wall is done to identify any underlying uterine disorders. The electrode is 4mm and it helps in cutting of the endometrium. In addition to this, the myometrium is also destroyed to eliminate the underlying endometrial basal cells.

The basal cells of the endometrium are also called basalis. They enable the multiplication and thickening of the endometrium forming the superficial layer of the endometrium which is shed out. The walls of the uterus are examined for bleeding points and then the patient is sent to the recovery room. Other modern techniques such as the administration of microwave endometrial ablation, cryoablation, diode laser phototherapy are considered.


Endometrial ablation is not advisable for patients who might be in early pregnancy, have a history of uterine cancer and menopause. Women who undergo endometrial ablation have a chance of conception; however there is a possibility of miscarriage. This happens because the uterine lining has been removed.

Endometrial ablation is also recommended as an alternative to hysterectomy. Endometrial ablation is also done on an outpatient basis with a given recovery time. The results of the endometrial ablation treatment include absence of menstrual bleeding. In some cases, there is a possibility of reduced bleeding. Consult a doctor in the case of spotting to identify the emergence of conditions such as fibroids or polyps of the uterus. Endometrial ablation procedure is widely administered among women in the age group of 30 to 45.

Endometrial Resection : The Loop Electrosurgical Excision Procedure(LEEP) is used to destroy the uterine lining. The use of LEEP is faster and provides faster recovery than any comparable surgical procedure.


Complications of Endometrial Ablation

The most significant complication is perforation caused to the uterus. In these cases laparoscopy is done. Other possibilities include perforations to organs such as the bladder, blood vessels and the organs in pelvic region.

The fluid absorption during the endometrial ablation procedure may result in the lowering of blood salt levels causing damage to the lungs and brain. In post-operative cases, vaginal bleeding is common for a few days. However, if the discharge or bleeding from the vagina is associated with foul smell, infections of the uterus are suspected. Women who have undergone the endometrial ablation procedure are generally advised to take progestogens which help in reducing the risk of uterine cancers. Sexual intercourse is advised only after two weeks to prevent vaginal bleeding or pain.

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Bibliography / Reference

Collection of Pages - Last revised Date: August 20, 2019