HYPERMENORRHEA
The causes of hypermenorrhea or excessive menstrual bleeding can be
easily recalled by simply applying the mnemonic MINTS.
M—Malformations include bicornuate uterus, congenital ovarian cysts,
endometriosis, ectopic pregnancies, and retained placenta.
I—Inflammation recalls cervicitis, endometritis, and pelvic
inflammatory disease.
N—Neoplasms include fibroids, carcinoma, and polyps of the cervix
and endometrium. One should also not forget choriocarcinoma, hydatidiform
moles, and hormone-producing tumors of the ovary.
T—Trauma includes perforation of the uterus, excessive intercourse
during the menses, and introduction of foreign bodies into the uterus.
S—Systemic diseases include anemia and the coagulation disorders
such as hemophilia, idiopathic thrombocytopenic purpura, and scurvy. Also in
this category are lupus erythematosus and endocrine disorders, especially
hypothyroidism and dysfunctional uterine bleeding from disproportion in the
output of estrogen and progesterone by the ovary.
Approach to the Diagnosis
The diagnosis includes a thorough pelvic examination, CBC, coagulation
studies, thyroid function tests, and perhaps other endocrine tests.
Ultrasonography is ordered next. If all these are normal, a trial of
estrogen or progesterone supplementation or a dilatation and curettage (D
& C) may be indicated. Culdoscopy, peritoneoscopy, and a
hysterosalpingogram may be necessary before performing an exploratory
laparotomy and, if necessary, a hysterectomy. A gynecologist or
endocrinologist will be helpful in solving the diagnostic dilemma in many
cases.
CASE PRESENTATION #49
An 18-year-old Puerto Rican woman complained of increasing and prolonged
periods for the past 14 months. She had also experienced arthralgias, weight
loss, and fatigue. Her pregnancy test is negative.
Pictures
Book Source Details
- Book Title: Differential Diagnosis in Primary Care
- Author(s): R. Douglas Collins MD, FACP
- Year of Publication: 2007
- Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2007 Lippincott Williams & Wilkins.
Other Book Chapters Related to Heavy periods
Read excerpts from these other book chapters related to Heavy periods:
Medical Books Excerpts
- Metrorrhagia
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
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- Menorrhagia
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
- [ read ]
- Menorrhagia
- "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
- [ read ]
Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2008 Williams & Wilkins.
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