Overview
What are the signs and symptoms of menorrhagia?
What is included in the physical exam for menorrhagia?
What is included in the general exam for menorrhagia?
What is included in the pelvic exam for menorrhagia?
When should a diagnosis of menorrhagia be considered?
Which lab tests are performed in the diagnosis of menorrhagia?
Which imaging studies and procedures are performed in the evaluation of menorrhagia?
What is the role of surgery in the treatment of menorrhagia?
What is the pathophysiology of menorrhagia?
How are the etiologies of menorrhagia categorized?
What are the organic causes of menorrhagia?
What are the endocrine causes of menorrhagia?
What are the anatomic causes of menorrhagia?
What are the iatrogenic causes of menorrhagia?
How is a bleeding disorder etiology of menorrhagia diagnosed?
What is the prevalence of menorrhagia in the US?
Which age groups are at highest risk for menorrhagia?
What is the prognosis of menorrhagia?
What is the morbidity associated with menorrhagia?
What are factors that affect the successful treatment of menorrhagia?
What is included in patient education about menorrhagia?
Presentation
What is the role of clinical history in the diagnosis of menorrhagia?
What condition must be excluded before further evaluation of menorrhagia?
How is bleeding characterized in menorrhagia?
How does the etiology of menorrhagia vary by age?
What is the significance of pelvic pain in the evaluation of menorrhagia?
Which clinical history findings suggest an anovulation etiology for menorrhagia?
Which infections may cause menorrhagia?
What is the role of contraceptive use in the etiology of menorrhagia?
What are the signs and symptoms of polycystic ovarian syndrome in patients with menorrhagia?
What are symptoms of a pituitary tumor in patients with menorrhagia?
Which systemic diseases may cause menorrhagia?
What is the role of thyroid dysfunction in menorrhagia?
What is the significance of excessive bruising in patients with menorrhagia?
What is the role of medications in the etiology of menorrhagia?
What is included in the physical exam for menorrhagia?
What should be included in the pelvic exam for menorrhagia?
DDX
What are the initial tests performed in the evaluation of menorrhagia?
Which conditions should be included in the differential diagnoses of menorrhagia?
What are the differential diagnoses for Menorrhagia?
Workup
What is the role of a CBC count in the workup of menorrhagia?
What is the role of iron studies in the workup of menorrhagia?
What is the role of coagulation factor studies in the workup of menorrhagia?
What is the role of human chorionic gonadotropin testing in the workup of menorrhagia?
What is the role of thyroid function tests in the workup of menorrhagia?
What is the role of liver and renal function tests in the workup of menorrhagia?
What is the role of hormone assays in the workup of menorrhagia?
What is the role of a Pap smear in the workup of menorrhagia?
What is the role of imaging studies in the workup of menorrhagia?
What is the role of hysteroscopy in the workup of menorrhagia?
What is the role of endometrial biopsy in the workup of menorrhagia?
Which histologic findings are characteristic of menorrhagia?
Treatment
What is the role of NSAIDs in the treatment of menorrhagia?
What is the role of oral contraceptives in the treatment of menorrhagia?
What is the role of progestin therapy in the treatment of menorrhagia?
What is the role of the levonorgestrel intrauterine system in the treatment of menorrhagia?
What is the role of gonadotropin-releasing hormone (GnRH) agonists in the treatment of menorrhagia?
What is the role of danazol in the treatment of menorrhagia?
What is the role of conjugated estrogens in the treatment of menorrhagia?
What is the role of tranexamic acid in the treatment of menorrhagia?
What is the role of dilatation and curettage (D&C) in the treatment of menorrhagia?
What is the role of surgery in the treatment of menorrhagia?
What is the role of transcervical resection of the endometrium in the treatment of menorrhagia?
What is the role of roller-ball endometrial ablation in the treatment of menorrhagia?
What is the role of endometrial laser ablation in the treatment of menorrhagia?
What is the role of thermal balloon therapy in the treatment of menorrhagia?
What is the role of the HydroThermAblator (HTA) for the treatment of menorrhagia?
What is the role of cryoablation in the treatment of menorrhagia?
What is the role of microwave endometrial ablation (MEA) in the treatment of menorrhagia?
What is the NovaSure system for the treatment of menorrhagia?
What is the role of endometrial ablation in the treatment of menorrhagia?
What is the role of myomectomy in the treatment of menorrhagia?
What is the role of hysterectomy in the treatment of menorrhagia?
Medications
What is the treatment algorithm for acute menorrhagia?
What is the treatment algorithm for chronic menorrhagia?
Which medications in the drug class Estrogens are used in the treatment of Menorrhagia?
Which medications in the drug class Androgens are used in the treatment of Menorrhagia?
Which medications in the drug class Progestins are used in the treatment of Menorrhagia?
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Acute menorrhagia requires prompt medical intervention. This is bleeding that will compromise an untreated patient.
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Successful treatment of chronic menorrhagia is highly dependent on a thorough understanding of the exact etiology. For instance, acute bleeding postpartum does not respond to progesterone therapy, while anovulatory bleeding worsens with high-dose estrogen.
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