Introduction
Menorrhagia, or heavy menstrual flow, is one of the greatest common complaints met by primary care doctors and gynecologists. It is defined as menstrual loss of more than 80 mL. This translates to menses that continues for more than seven days or the use of more than 10 pads or tampons per day. It is most commonly associated with perimenopause. (1) Although menorrhagia is not fatal, it can cause chronic anemia, pelvic pain and cramping. The condition also severely influences quality of life by disrupting work, social functioning and family life.(2) The old-style primary management for menorrhagia caused by submucosal myomas or endometrial polyps involved major surgical procedure, with menorrhagia responsible for almost 20 percent
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Between 5 and 10 percent of all U.S. women complain to their doctors about menorrhagia (3), which affects more than 10 million annually. (2)
Menorrhagia can have hormonal or non-hormonal causes. Uterine fibroids, or myomas, are a common non-hormonal cause. (1) Clinically, there are three main categories of myomas, classified according to their site in the uterus: subserosal myomas grow in the outer portion of the uterus, intramural myomas develop within the uterine wall, and submucosal myomas grow just below the lining of the uterine cavity and close to the endometrial cavity. This last group of myomas, the submucosal, that have the most effect on menorrhagia.(4,5) Because of their location on the endometrium, these myomas place pressure on the uterine lining that builds with each menstrual cycle. This, in turn, can cause heavy bleeding. Even very small submucosal myomas may cause very heavy bleeding.(4,5) Myomas in the submucosal location specifically may cause abnormal uterine bleeding or subfertility, and are agreeable to hysteroscopic removal. The European Society of Gynecological Endoscopy (ESGE) classifies submucosal myomas as Type 0 if the entire lesion is intracavitary, Type I if less than 50% extends into the myometrium, and Type
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It is quicker, simpler, safer lesion removal. In 2005, the US Food and Drug Administration (FDA) approved the TRUCLEAR™ hysteroscopic morcellator (Smith & Nephew, Andover, MA) as the first motorized morcellator for intrauterine pathology. In 2009, the FDA approved another hysteroscopic morcellation device—the MyoSure® Tissue Removal System (Hologic, Bedford, MA). Similar to the first generation TRUCLEAR, the second generation MyoSure system depends on a suction-based, mechanical energy, rotating tubular cutter system rather than the high-frequency electrical energy historically used by resectoscopy systems to eliminate intrauterine tissue.(20) Once placed inside the uterine cavity, the device shaves off and immediately suctions out any excised tissue that might impair visibility. The ability to remove and instantly suction out tissue fragments means the hysteroscopy and morcellator are inserted only once, for initial entry. This is a huge advantage from both the physician's and the patient's point of view. For the physician, the immediate removal of tissue through the probe makes surgery much simpler to perform and requires less surgical time. The advantage for the patient is a much safer treatment. Shorter operating time means less exposure to general anesthesia and puts the
Uterine leiomyoma also known as uterine fibroids are non-cancerous tumors in women during childbearing age. The tumors come from smooth muscle cells of the myometrium within the uterus that changes in size and cellular properties during the reproductive years of a woman. The change in size and cellular property with hypertrophy of the smooth muscle cells normally happen during pregnancy and also occur with uterine fibroids. The development of the tumors is dependent upon estrogen and progesterone and interaction with growth factors, cytokines and extracellular matrix components (Taylor, Holthouser,
A multidisciplinary approach is taken to provide safe, effective treatment while minimizing patient risk. Patients are treated due to chronic pelvic pain issues, with or without subfertility considerations. The FNP can prescribe NSAIDS to address pelvic pain issues. Steroid hormone derived medications like oral contraceptives are also prescribed to suppress growth and activity of the endometrial implants and provide cycle control. If this approach is ineffective, gonadotropin-releasing hormone (GnRH) agonists like Leuprolide can be prescribed for up to a year to significantly decrease estrogen levels, thereby decreasing chronic pelvic pain (Solnik, 2015). However, the FNP can also counsel hormone therapy to reduce menopausal effects on bone mineral density and serotonin reuptake inhibitors (SSRIs) to address vasomotor symptoms like hot flashes Another effective hormonal pharmaceutical therapy includes progesterone like medroxyprogesterone acetate and anti-progestin. As well, in advanced disease the FNP may elect to implant the levonorgestrel intrauterine device (IUD) as a progestin derived alternative (Schenken,
The first item that is going to be look at it is a basic overview of endometriosis. Endometriosis is a painful chronic disease
Polycystic Ovary Syndrome (PCOS) is a common endocrine disorder that affects 4% to 12% of women of childbearing age.1 The proportion of individuals in a population with PCOS depends on the diagnostic criteria.2 According to the criteria implemented by the European Society for Human Reproduction and Embryology/American Society for Reproductive Medicine, PCOS is as great as 15% to 20%.2 As stated in The National Institute of Health Office of Disease Prevention Report, PCOS impacts about 5 million females of reproductive age in United States.3 The identification and management of the disease is estimated to cost $4 billion annually to the US health care system.3 As such, PCOS presents a major economic burden.
Fatigue, diarrhea, constipation, bloating and nausea are some of the other symptoms you may experience with endometriosis. Menorrhagia can be a symptom of endometriosis, which is characterized by soaking through one or more pads or tampons every hour for several consective hours, needing to double up on pads to protect the control of you period, and needing to wake up during the night to change your sanitary products. You may also experience anemia, tiredness, fatigue and short of breath due to the blood loss. (Mayo Clinic
When caring for women with menorrhagia, it is essential to explore a complete health history and workup. These steps can help identify patterns and underlying pathology. Once these differentials can be ruled out of potential possibilities, then the plan and options can be tailored the needs of each
Hysterectomy is one of the commonest gynecologic procedures, with approximately 600,000 women undergoing this procedure annually in the United States for various indications.9
Hemorrhoids are also known as Piles, and are essentially swollen veins that occur in the lining of the rectal passage. Symptoms can usually vary from itching, swelling, pain and bleeding. Hemorrhoids start forming internally (Internal Hemorrhoids) and eventually can stretch downwards and protrude out the anus as lumps known as External Hemorrhoids.
Know about hemorrhoids before knowing how long do hemorrhoids last? Hemorrhoids in many cases are brought on by a rise inside your intra-abdominal that puts a strain on the veins inside your pelvic and anal places. These veins don't have valves such as the veins inside arms legs and arms; therefore, all of the pressure inside your stomach is sent straight to them creating them to distend, shed their flexibility, and also you encounter discomfort once they are over-stretched. Most typical reasons for piles are bad bowel habits.
The Lady Forum is a non-promotional activity that has the main objective to approach in an integral way the pathologies that affects all women in the today´s world. With the important collaboration of four Novartis franchises, the Lady Forum agenda provides practical recommendations in select female disease areas and allows for physicians to get a deep understanding on how those pathologies affect the patients.
This could be a symptom of gynecologic cancer, especially when you have a heavy periods and bleeding between periods. Bleeding during and after sex could also indicate and link to cervical, uterine, and ovarian cancer.
Polycystic ovary syndrome (PCOS) is a condition that is estimated to effect between 6% and 10% of reproductive age women (Andreou, Barber, Dimitriadis, & Franks, 2016). In this paper we will define PCOS, examine the pathogenesis, identify ways to assess for the condition and review the treatment options on a mock patient.
It is estimated that symptomatic POP affects 30% of females over 20 years of age (Nygaard, Barber, Burgio, et al., 2008); with rates increasing to 38 - 41% in postmenopausal women (Hendrix, Clark, Nygaard, et al., 2002). Studies utilizing the POP-Q suggest a bell-shaped curve for the distribution of POP by stage classification. For example, the prevalence of POP in a community-based clinic for routine gynecologic care had the following distribution: stage 0, 6.4 percent; stage 1, 43.3 percent; stage 2, 47.7 percent; and stage 3, 2.6 percent (Swift, 2000;
Some might not even notice they are bleeding more than they usually do in a particular cycle, and they are using more sanitary products than they normally would. Some women’s periods may last longer than the typical 3 to 7 days, but they may discount the importance of that as well. However, heavy bleeding during periods and cycles that stretch beyond 7 or 8 days might be indicative of a fibroid growth. A fibroid is a noncancerous, fibrous and muscular growth that appears in or around the uterus. Heavy and prolonged bleeding is the most commonly reported symptom among women suffering from fibroids, according to a 2014 study published in The International Journal of Women’s Health. Occasionally, you may also notice the presence of blood clots in your menstrual flow. This, too, can be a sign of fibroids.
If a fibroid is large it can put extreme pressure on the lower pelvic floor and structures. Oftentimes, these fibroids may bleed out heavily either during a woman's menstrual cycle, or during unexpected times.