MENORRHAGIA (Part Three)
DIFFERENTIAL DIAGNOSIS:
- Adnexal tumors
- Adrenal carcinoma
- Anovulation
- Cervicitis
- Spontaneous abortion
- Endometrial carcinoma
- Endometritis
- Gestational trophoblastic neoplasia.
- Hyperprolactinemia
- Hyper - Hypothyroidism
- Obesity
- Pelvic inflammatory disease
- Pituitary microadenomas
- Pregnancy
- Uterine cancer
- Vaginitis
TREATMENT:
Medication:
- Nonsteroidal anti-inflammatory drugs (NSAIDs) – naproxen, diclofenac, etc.
- Oral contraceptives. Long-term use of a combination of estradiol valerate and dienogest has been proven to be very effective in the treatment of menorrhagia.
- Progestin- medroxyprogesterone (Provera) - antiestrogenic.
- Intrauterine devices with levonorgestrel.
- Gonadotropin-releasing hormone agonist (GnRH agonist) which are used for a short period due to high cost and numerous side effects. They inhibit the pituitary release of LH, FSH leading to hypogonadism
- Danazol (Danocrine) – causes amenorrhea from 4-6 weeks and androgenic effects like acne, breast volume reduction, and often voice deepening.
- Conjugated estrogens – administered intravenously every 4 hours in patients with acute hemorrhage. If there is no result within 24 hours, continue with the dilation – curettage procedure.
- Tranexamic acid has an antifibrinolytic effect by inhibiting the activation of plasminogen to plasmin.
Surgical:
- Dilation and curettage – used for diagnosis as much as for treatment.
- Transcervical resection of the endometrium (TCRE). It is done through a resectoscope, hysteroscopy and the main risk is perforation of the uterus.
- Endometrial ablation with laser. The laser is inserted into the uterus through hysteroscopy.
- Endometrial ablation without resectoscopy which include:
- With thermal balloon catheter – a catheter with a balloon filled with NaCl isotonic solution heated to 87 degrees Celsius for 8 minutes that is inserted into the endometrial cavity.
- With hysteroscopy – NaCl solution heated to 90 degrees Celsius for 10 minutes is introduced into the uterine cavity.
- Cryoablation – liquid nitrogen is used to freeze the endometrium. The procedure lasts for 10 minutes and is done under ultrasound guidance.
- Endometrial ablation with microwaves.
- Myomectomy is usually used when there is one or a few myomas and when the woman wants to preserve the uterus and fertility.
- Hysterectomy