Menorrhagia and metorrhagia

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1. 01 Menorrhagia and Metorrhagia
3rd Year {Bsc(Honors) }
Insha Aziz Insha Aziz

2. Menorrhagia is the most common type of abnormal uterine
bleeding characterized by heavy and prolonged menstrual
bleeding. A normal menstrual cycle is 21-35 days in
duration, with bleeding lasting an average of 5 days and
total blood flow between 25 and 80 mL. A blood loss of
greater than 80 ml or lasting longer than 7 days constitutes
menorrhagia
(also called hypermenorrhea)
MENORRHAGIA

3. Etiology
Hormone imbalance. If a hormone imbalance occurs between the
hormones estrogen and progesterone, the endometrium develops in
excess and eventually sheds by way of heavy menstrual bleeding.
2 Dysfunction of ovaries
Dysfunction of the ovaries. If ovaries don't ovulate during a menstrual
cycle (anovulation),body doesn't produce the hormone progesterone, as it
would during a normal menstrual cycle. This leads to hormone imbalance
and may result in menorrhagia.
1 Harmonal imbalance

4. Etiology
3 Uterine fibroids
Uterine fibroids. These noncancerous (benign)
tumors of the uterus which may
also induce menorrhagia.
4 Polyps
Small, benign polyps may cause heavy or
prolonged menstrual bleeding.

5. This condition occurs when glands from
the endometrium become
embedded in the uterine muscle, often
causing heavy bleeding and pain.
Etiology
5 Adenomyosis
6 IUD
Menorrhagia is a well-known
side effect of using a
nonhormonal intrauterine
device for birth control.

6. Miscarriage, Ectopic pregnancy
Etiology
7 Pregnancy Complications
8 Cancer
Rarely uterine cancer, ovarian cancer, and cervical cancer
9 Inherited bleeding disorder
Von Willebrand's disease, thrombocytopenia,leukemia
10 Medications
PID(PELVIC INFLAMMATORY DISEASE), THYROID
PROBLEM'S(Hypothyroidism), Endometriosis, liver or kideney disease
11 Other Medical conditions
Certain drugs, Anti-inflamtory medications (Aspirin) and Anticoagulants

7. Absence of progesterone
Menorrhagia
Lack of vasoconstriction
Deficiency of factor (Vii, ix)
Results in excessive uterine bleeding
Deficiency of factor (ii,Vii, ix, x)
Results in excessive uterine bleeding
Inherited bleeding disorders
(von willebrand's disease),
Coagulation disorders
(thrombocytopenia,leukemia)
Lack of ovulation(anovulation)
It puts pressure against
the uterine lining
Estrogen and progesterone doesn't regulate
the buildup of lining of uterus (endometrium)
Eventually it sheds by way of heavy
menstrual bleeding
Blood vessels bleed increasing menstrual
flow
Deficiency of vit K due to its high requirement by
vit K dependent protein to inhibit calcification
Dysfunctiona of ovaries
Absences or low levels of PGF2 alpha
Uterine fibroids
Uterus is unable to contract
properly to stop bleeding
Hormonal imbalance
Endometrium develops in excess
Polyps
Irritate the surrounding tissue
Tissue rub off exposing tiny blood vessels
Kidney disease
Liver disease
Defect in hemostasis

9. Pelvic and Rectal
Examination
Diagnostic Evaluation
Pap Smear
cells from cervix are collected and
tested for infection, inflammation or
cancerous changes.

10. Diagnostic Evaluation
Blood tests
Evaluate for iron deficiency (anemia) and other conditions,
such as thyroid disorders or blood-clotting abnormalities.
Endometrial Biopsy
Endometrial biopsy. is the removal of a small piece of
tissue from the endometrium (the lining of the uterus).

12. Diagnostic Evaluation

20. METRORRHAGIA

22. Clinical Manifestation
Mild or heavy bleeding
Profuse sticky discharge
Intermittent cramping pain of short duration
Metrorrhagia caused by miscarriage or a tubal pregnancy almost always
always includes cramping, which can be severe
1
4
3
2
Diagnostic Evaluation
Physical examination
rectovaginal examination
Hysteroscopy
.
.
.
Complete Medical History
.
Sonohysterogram
.
Hysteroscopy
.
Hysterosalphingography
.
(Pelvic examination)

24. The nurse should assess
and obtain health history,
noting when the bleeding
started,how long it lasts ,if
u have ever been pregnant
and child birth.
A nutritional history is also
obtained to determine if
the diet is high in
salt,caffeine or alcohol or
low in essential nutrients.
Assess the level of
understanding
regarding the
menstrual disorders
Nursing diagnosis Goal
Acute pain related to
menstrual cramps ,
increased uterine
contractions or
hypersensitivity to
prostaglandins
To realive Pain
Nursing Interventions Evaluation
Assess Intensity, location, level & onset.
.
.
For relief of painfull menstrual cramps and
associated discomfort, start with a Hot bath. (The
water helps relax the uterus and other tensions that
may contribute to the problem.
.
.
Exercise regularly Aerobic exercises such
as swimming, running, bicycling may
diminish Cramp Symptoms.
Place a heating pad on abdomen, the flow
of heat can provide soothing, temporary
pain relief
.
Teach the use of Relaxation techniques like
yoga, meditation etc
.
Administer analegeses as prescribed .
Advise patient to avoid those factors which
elevate pain
.
After using following
interventions patient
Pain is relieved
.

25. Nursing diagnosis Goal
Nursing Interventions
Evaluation
.
.
.
.
.
.
.
Imbalanced nutrition
related nausea,
vomiting or apetite
changes, food
cravings,
To improve
nutritional
status
Monitor body weight
Advise patient to eat smaller, more frequent
meals to reduce bloating & sensation of fullness
Choose foods high in carbohydrates, such as
fruits,vegetables & whole grains


Take a daily multivitamin supplements


Take a daily iron supplements to prevent
iron deficiency anemia


By using following
interventions
nutritional status is
improved
.
Anxiety related to
excessive bleeding
loss, altered day to
day life activities

To reduce
anxiety
.
Encourage the pateint To use exercise & creative activities
to reduce stress
.
Encourage the pateint To use relaxation techniques like
Yoga,Meditation,massage therapy etc ..
.
Pateint is encouraged to continue her usual activities as
this seems to relieve discomfort for some women
.
By using following
interventions
Anxiety is reduced