Chapter 117 Menorrhagia
INTRODUCTION
Description: Menorrhagia—heavy menstrual flow—is generally divided into primary and secondary. Secondary is caused by (secondary to) some clinically identifiable cause; primary is caused by a disturbance of prostaglandin production. Menorrhagia is generally distinguished from acute vaginal bleeding (most often associated with pregnancy and pregnancy complications).
ETIOLOGY AND PATHOGENESIS
Causes: Secondary—see differential diagnosis following. Primary—overproduction, or an imbalance in the relative ratios of uterine prostaglandins (prostaglandin E2, prostaglandin I2, and thromboxane A2). Some evidence suggests that patients with primary menorrhagia may also have increased fibrinolysis, further enhancing a tendency to bleed.
CLINICAL CHARACTERISTICS
DIAGNOSTIC APPROACH
Differential Diagnosis
• Nongynecologic causes include blood dyscrasia or coagulopathy, hypothyroidism, leukemia, hepatic or renal disease, systemic lupus erythematosus, thyroid disease
Workup and Evaluation
Imaging: Pelvic ultrasonography (based on diagnosis being considered—limited to the detection of secondary sources).
