Menorrhagia
Abnormally heavy or long menstrual bleeding, menorrhagia may occur as a single episode or a chronic sign. In menorrhagia, bleeding is heavier than the patient’s normal menstrual flow; menstrual blood loss is 80 ml or more per monthly period. A form of dysfunctional uterine bleeding, menorrhagia can result from endocrine and hematologic disorders, stress, and certain drugs and procedures.
Emergency Interventions
Evaluate hemodynamic status by taking orthostatic vital signs. Insert a large-gauge I.V. line to begin fluid replacement if the patient shows an increase of 10 beats/minute in pulse rate, a decrease of 10 mm Hg in systolic blood pressure, or other signs of hypovolemic shock, such as pallor, tachycardia, tachypnea, and cool, clammy skin. Place the patient in a supine position with her feet elevated, and administer supplemental oxygen as needed.
Use menstrual pads to obtain information related to the quality and quantity of bleeding. Then prepare the patient for a pelvic examination to help determine the cause of bleeding.
History and physical examination
When the patient’s condition permits, obtain a history. Determine her age at menarche, the average duration of menstrual periods, and the interval between them. Establish the date of the patient’s last menses, and ask about any recent changes in her normal menstrual pattern. Have the patient describe the character and amount of bleeding. For example, how many pads or tampons does the patient use? Has she noted clots or tissue in the blood? Also ask about the development of other signs and symptoms before and during the menstrual period.
Next, ask if the patient is sexually active. Does she use a method of birth control? If so, what kind? Could the patient be pregnant? Be sure to note the number of pregnancies, the outcome of each, and any pregnancy-related complications. Find out the dates of her most recent pelvic examination and Papanicolaou smear and the details of any previous gynecologic infections or neoplasms. Also, be sure to ask about any previous episodes of abnormal bleeding and the outcome of any treatment. If possible, obtain a pregnancy history of the patient’s mother, and determine if the patient was exposed in utero to diethylstilbestrol. (This drug has been linked to vaginal adenosis.)
Be sure to ask the patient about her general health and medical history. Note particularly if the patient or her family has a history of thyroid, adrenal, or hepatic disease; blood dyscrasias; or tuberculosis because these may predispose the patient to menorrhagia. Also, ask about the patient’s past surgical procedures and any recent emotional stress. Find out if the patient has undergone X-ray or other radiation therapy, because this may indicate prior treatment for menorrhagia. Obtain a thorough drug and alcohol history, noting the use of anticoagulants or aspirin. Perform a pelvic examination, and obtain blood and urine samples for pregnancy testing.
Medical causes
Blood dyscrasias
Menorrhagia is one of several possible signs of a bleeding disorder. Other possible associated findings include epistaxis, bleeding gums, purpura, hematemesis, hematuria, and melena.
Endometriosis
Menorrhagia may be a sign of this disorder, in which endometrial tissue is found outside the lining of the uterine cavity. However, the classic symptom is dysmenorrhea. Other findings depend on the location of the ectopic tissue outside the uterus but may include dyspareunia, suprapubic pain, dysuria, nausea, vomiting, abdominal cramps, cyclic pelvic pain, and infertility. Often a tender, fixed adnexal mass is palpable on bimanual examination.
Hypothyroidism
Menorrhagia is a common early sign and is accompanied by such nonspecific findings as fatigue, cold intolerance, constipation, and weight gain despite anorexia. As hypothyroidism progresses, intellectual and motor activity decrease; the skin becomes dry, pale, cool, and doughy; the hair becomes dry and sparse; and the nails become thick and brittle. Myalgia, hoarseness, decreased libido, and infertility commonly occur. Eventually, the patient develops a characteristic dull, expressionless face and edema of the face, hands, and feet.
Also, deep tendon reflexes are delayed, and bradycardia and abdominal distention may occur.
Uterine fibroids
Menorrhagia is the most common sign, but other forms of abnormal uterine bleeding as well as dysmenorrhea or leukorrhea, can also occur. Possible related findings include abdominal pain, a feeling of abdominal heaviness, backache, constipation, urinary urgency or frequency, and an enlarged uterus, which is usually nontender.
Other causes
Drugs
Use of a hormonal contraceptive may cause sudden onset of profuse, prolonged menorrhagia. Anticoagulants have also been associated with excessive menstrual flow. Injectable or implanted contraceptives may cause menorrhagia in some women.
Herb Alert
Herbal remedies, such as ginseng, can cause postmenopausal bleeding.
Intrauterine devices
Menorrhagia can result from the use of intrauterine contraceptive devices.
Special considerations
Continue to monitor the patient closely for signs of hypovolemia. Encourage the patient to maintain adequate fluid intake. Monitor intake and output, and estimate uterine blood loss by recording the number of sanitary napkins or tampons used during an abnormal period and comparing this with usage during a normal period. To help decrease blood flow, encourage the patient to rest and to avoid strenuous activities. Obtain blood samples for hematocrit, prothrombin time, partial thromboplastin time, and international normalized ratio levels.
Pediatric pointers
Irregular menstrual function in young girls may be accompanied by hemorrhage and resulting anemia.
Geriatric pointers
In postmenopausal women, menorrhagia cannot occur. In such patients, vaginal bleeding is usually caused by endometrial atrophy. Malignancy must be ruled out.
Book Source Details
- Book Title: Professional Guide to Signs & Symptoms (Fifth Edition)
- Author(s): Springhouse
- Year of Publication: 2006
- Copyright Details: Professional Guide to Signs & Symptoms (Fifth Edition), Copyright © 2006 Lippincott Williams & Wilkins.
Other Book Chapters Related to Vaginal discharge
Read excerpts from these other book chapters related to Vaginal discharge:
Medical Books Excerpts
- ODOR
- "Algorithmic Diagnosis of Symptoms and Signs" (2003)
- [ read ]
- Dysmenorrhea
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
- [ read ]
- Menorrhagia
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
- [ read ]
- Metrorrhagia
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
- [ read ]
- Dysmenorrhea
- "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
- [ read ]
- Menorrhagia
- "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
- [ read ]
- Urethral Discharge
- "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
- [ read ]
- Vaginal Discharge
- "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
- [ read ]
- Breath odor, fecal
- "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
- [ read ]
Copyright Details: Professional Guide to Signs & Symptoms (Fifth Edition), Copyright © 2008 Williams & Wilkins.
More About Causes of Vaginal discharge
» Next page: Metrorrhagia (Professional Guide to Signs & Symptoms (Fifth Edition))
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