Menorrhagia
Menorrhagia is regular cyclic bleeding at normal intervals but excessive in amount (>80ml) or duration (>7 days).
Etiology (Causes):
1. Organic Causes
- Fibroid Uterus
- Adenomyosis
- Pelvic Endometriosis
- Chronic Tubo-Ovarian Mass
- Tubercular Endometritis
- Retroverted Uterus (Congenital)
- Granulosa Cell Tumor of Ovary
- Congestive Cardiac Failure
- Severe Hypertension
2. Endocrinal Causes
- Hypothyroidism
- Polycystic Ovarian Syndrome (PCOS)
- Hyperprolactinemia
3. Hematological Disorders
- Thrombocytopenic Purpura
- Leukemia
- Platelet Dysfunction Disorders
4. Functional Causes
- Disturbed Hypothalamo-Pituitary-Ovarian Axis
- Altered Endometrial Prostaglandins
Clinical Features
- Heavy prolonged menstrual bleeding
- Increased use of sanitary pads (>6-8 per day)
- Pallor due to anemia
Investigations
- Complete Blood Count (CBC) – Check for anemia
- Thyroid Function Tests – To rule out hypothyroidism
- Pelvic Ultrasound – Detects fibroids, endometrial thickness
- Endometrial Biopsy – Rule out malignancy
Treatment
1. Medical Treatment
- NSAIDs (Mefenamic Acid, Ibuprofen) – Reduces bleeding and pain
- Hormonal Therapy
- Oral Contraceptive Pills (OCPs) – Regulates bleeding
- Progesterone Therapy – For endometrial protection
- GnRH Agonists – For severe cases
- Iron Supplements – Correct anemia
2. Surgical Treatment
- Dilatation & Curettage (D&C) – Diagnostic & therapeutic
- Endometrial Ablation – Reduces endometrial thickness
- Hysterectomy – In refractory cases
Metrorrhagia
Metrorrhagia is irregular, intermenstrual bleeding that is not related to the menstrual cycle.
Etiology (Causes):
1. Benign Causes
- Endometrial Polyps
- Chronic Endometritis
- Hormonal Imbalance (Anovulatory Cycles)
2. Malignant Causes
- Endometrial Carcinoma
- Cervical Cancer
- Ovarian Tumors
3. Iatrogenic Causes
- Breakthrough bleeding due to oral contraceptive pills (OCPs)
- Use of intrauterine contraceptive devices (IUCDs)
Clinical Features
- Irregular vaginal bleeding between cycles
- No relation to ovulation or menstruation
- Postcoital bleeding in some cases
Investigations
- Pap Smear & Colposcopy – To detect cervical pathology
- Endometrial Biopsy – Rule out endometrial carcinoma
- Transvaginal Ultrasound (TVUS) – To detect polyps and fibroids
Treatment
1. Medical Treatment
- OCPs or Progesterone Therapy – For hormonal imbalance
- Antibiotics – If infection is present
2. Surgical Treatment
- Polypectomy – If polyps are the cause
- Hysteroscopy & Endometrial Curettage – For diagnosis and management
- Hysterectomy – In confirmed malignant cases
Keynote Symptoms of Menorrhagia & Metrorrhagia
- Excessive, prolonged, or irregular menstrual bleeding
- Bright red or dark clotted blood with severe cramping pain
- Weakness, dizziness, and paleness due to excessive blood loss
- Intermenstrual spotting or continuous heavy flow
- Anemia, fainting, and exhaustion after heavy bleeding
1. Sabina
Indications:
- Menorrhagia with bright red bleeding and large clots
- Uterine bleeding that worsens with the slightest motion
Keynote Symptoms:
- Pain radiates from the sacrum to the pubis.
- Profuse bleeding, worse with movement.
- Strong dragging-down sensation in the pelvis.
- Worse from heat, movement, and exertion.
- Better by resting and applying cold applications.
2. Trillium Pendulum
Indications:
- Flooding type of bleeding with faintness and weakness
- Heavy menstrual bleeding due to fibroids or menopause
Keynote Symptoms:
- Uterine hemorrhage with extreme exhaustion and fainting.
- Sensation as if hips and back are falling apart.
- Bright red, gushing blood that stops and starts again.
- Better by lying down and pressing the abdomen.
- Worse with movement.
3. Phosphorus
Indications:
- Frequent, prolonged, and painless uterine bleeding
- Intermenstrual spotting and postmenopausal bleeding
Keynote Symptoms:
- Bright red, excessive, and painless bleeding.
- Weakness, dizziness, and craving for cold drinks.
- Bleeding tendency from gums, nose, and other areas.
- Extreme thirst for cold water.
- Worse from lying on the left side.
4. Ferrum Metallicum
Indications:
- Menorrhagia with anemia and extreme weakness
- Heavy bleeding followed by paleness and dizziness
Keynote Symptoms:
- Profuse, long-lasting periods with extreme fatigue.
- Pale complexion with red flushing at times.
- Increased appetite despite weakness.
- Cold sensitivity and exhaustion.
- Worse after exertion or walking.
5. Millefolium
Indications:
- Passive, painless uterine bleeding with bright red blood
- Postpartum hemorrhage or bleeding after trauma
Keynote Symptoms:
- Hemorrhage is profuse, bright red, and painless.
- Nosebleeds often accompany menstrual bleeding.
- Better in the open air.
- Bleeding due to overexertion or injury.
- No clot formation in menstrual flow.
