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menstrual disorders
Dr O. BenGharbia
MRCGP, MD, MSc Sci
Case 1. Menorrhagia
A 43-year-old , got 2 children, LMP 21
days ago, presents with heavy
menstrual bleeding. In the last 6
months there has been a change with
menses coming every 25-32 days,
lasting 7-10 days and associated with
cramps not relieved by ibuprofen,
passing clots.
Prior to 6 months ago her cycles came
every 28-30 days, lasted for 6 days,
and were associated with cramps that
Conti, case 1
She denies dizziness, but complains
Conti, case 1
On examination;
BP=130/88; P= 100; Ht=158 cm; Wt=68 kg .
menstrual cycle?
Endometrial
Iatrogenic
What are the appropriate lab tests that should be ordered in this patient?
Results of investigation
Labs show Hgb: 9 gr/100 dl., HCT: 27%, HCG:
sonohysterogram
Hysterosalpingogram
Diagnostic hysteroscopy
Endometrial evaluation of
menorrhagia
Endometrial
Biopsy
Sensitivity -91%
Transvaginal
Ultrasound (TVS)
Sensitivity -88%
False positive
rate -2%
Saline Infusion
Sonohysterosc-
Sensitvity -97%
Opy (SIS)
Sensitivity -100%
Menorrhagia,
medical
management
NSAIDs, 30% 1 line, 5 days, decrease prostaglandins
Anti fibrinolyltic (transamine) 50% decrease in
st
blood flow)
OCPs, esp. if contraception desired, up to 60% dec. supp. HP axis
Oral continous progestins (day 5 to 26), most
prescribed, antiestrogen, downregulates endormetrium
Menorrhagia, surgical
management
Ablation
Myomectomy
polypectomy
Surgical
?D&C
Hysterectomy
Menorrhagia, surgical
management
Ablation
1st Generation
Resection
(TCRE)
2nd Generation
Cryoablation
Rollerball
Radiofrequency
Thermal
Baloon
Microwave
Case 2; dysmenorrhea
A 14-year-old female comes to the clinic,
Case 2 conti,
Physical exam:
The patients general and systemic
Discussion Questions
What is the differential diagnosis and
Case 3; Amenorrhea
A 26-year-old seen at clinic complaining of no
periods for 9 months. She got 2 children, ages are 5
and 3 years. She breastfed her youngest for 1 year,
menses returned right after she stopped, and were
monthly and normal until 9 months ago.
She is not using any contraception or any other
medication.
She feels very fatigued, has frequent headaches
and has had trouble losing weight.
She has no history of abnormal Paps or STIs.
She is married and works from home as a computer
consultant.
Examination
BP= 120/80, P= 64, Ht=164cm , Wt= 61 kg .
She appears tired but in no distress.
Breasts show scant bilateral milky white
Discussion Questions:
Results
Prolactin 12 ng/ml (normal range <22) &
On examination;
84 kg weight, height 158cm
BP 150/90 mmHg and temp 37.1 c
The heart and lung exam are normal The
Discussion Questions
What is the next step?
Perform an endometrial biopsy
endometrial cancer?
Thank You