Contemporary Concepts in Managing Menorrhagia.

Menorrhagia--technically defined as menses lasting longer than 7 days or a blood loss volume in excess of 60 to 80 mL--is one of the most common gynecologic complaints. It has been reported that 15% to 20% of otherwise healthy women experience debilitating menorrhagia. In the past, definitive treatment for abnormal uterine bleeding has been either abdominal or vaginal hysterectomy. Alternatives to hysterectomy are now stressed in light of the fact that nearly 50% of uterine specimens obtained during hysterectomies for menorrhagia are disease-free on pathologic examination. Etiologies are generally either endocrinologic or organic. Among the organic causes are coagulation disorders; organ dysfunction, such as liver or renal disease; endometrial hyperplasia; infection; iatrogenic causes, such as chemotherapy, anticoagulants, steroid therapy, and use of IUD; and anatomic causes, which include uterine leiomyoma, endometrial polyps, and pregnancy. Besides the history and physical exam, useful lab tests include CBC, serum pregnancy test, cervical specimens for gonorrhea and chlamydia, Pap smear, thyroid function tests, serum transaminases, luteinizing hormone, follicle-stimulating hormone, estradiol, prothrombin time, activated partial thromboplastin time, bleeding time, serum prolactin, quantitative beta human chorionic gonadotropin, blood urea nitrogen, serum creatinine, and adrenal function tests. Since many lesions are missed in office sampling or dilation and curettage, imaging studies, including ultrasound and hysteroscopy, can be useful in diagnosing the cause of menorrhagia. Medical treatments include drugs such as NSAIDS, progestins, oral contraceptives, and gonadotropin-releasing hormone agonists. Surgical modalities range from the relatively simple, such as D & C, to major surgical procedures such as hysterectomy. Laser ablation and thermal balloon ablation are promising new procedures.