Menorrhagia
Abnormally heavy or long menstrual bleeding, menorrhagia may occur as a single episode or a chronic sign. In menorrhagia, bleeding is heavier than the patient's normal menstrual flow; menstrual blood loss is 80 ml or more per monthly period. A form of dysfunctional uterine bleeding, menorrhagia can result from endocrine and hematologic disorders, stress, and certain drugs and procedures.
Action stat!
Evaluate the patient's hemodynamic status by taking orthostatic vital signs. Insert a large-gauge I.V. catheter to begin fluid replacement if the patient shows an increase of 10 beats/minute in pulse rate, a decrease of 10 mm Hg in systolic blood pressure, or other signs of hypovolemic shock, such as pallor, tachycardia, tachypnea, and cool, clammy skin. Place the patient in a supine position with her feet elevated, and administer supplemental oxygen as needed.
Monitor menstrual pads to obtain information related to the quality and quantity of bleeding. Prepare the patient for a pelvic examination to help determine the cause of bleeding.
History and physical examination
When the patient's condition permits, obtain a history. Determine her age at menarche, the duration of menses, and the interval between them. Establish the date of the patient's last menses, and ask about recent changes in her normal menstrual pattern. Have the patient describe the character and amount of bleeding. For example, how many pads or tampons does the patient use per period? Has she noted clots or tissue in the blood? Also ask about the development of other signs and symptoms before and during her menses.
Next, ask if the patient is sexually active. Does she use a method of birth control? If so, what kind? Could the patient be pregnant? Be sure to note the number of pregnancies, the outcome of each, and any pregnancy-related complications. Find out the dates of her most recent pelvic examination and Papanicolaou smear and the details of any previous gynecologic infections or neoplasms. Also, be sure to ask about previous episodes of abnormal bleeding and the outcome of any treatment. If possible, obtain a pregnancy history of the patient's mother, and determine if the patient was exposed in utero to diethylstilbestrol. (This drug has been linked to vaginal adenosis.)
Be sure to ask the patient about her general health and medical history. Note particularly if the patient or her family has a history of thyroid, adrenal, or hepatic disease; blood dyscrasias; or tuberculosis because these may predispose the patient to menorrhagia. Also, ask about the patient's past surgical procedures and recent emotional stress. Find out if the patient has undergone X-ray or other radiation therapy, because this may indicate prior treatment for menorrhagia. Obtain a thorough drug and alcohol history, noting the use of anticoagulants or aspirin. Prepare the patient for a pelvic examination, and obtain blood samples and urine specimens for pregnancy testing.
Medical causes
Blood dyscrasias.Menorrhagia is one of several possible signs of a bleeding disorder. Other possible associated findings include epistaxis, bleeding gums, purpura, hematemesis, hematuria, and melena.
Hypothyroidism.Menorrhagia is a common early sign of hypothyroidism and is accompanied by such nonspecific findings as fatigue, cold intolerance, constipation, and weight gain despite anorexia. As hypothyroidism progresses, intellectual and motor activity decrease; the skin becomes dry, pale, cool, and doughy; the hair becomes dry and sparse; and the nails become thick and brittle. Myalgia, hoarseness, a decreased libido, and infertility commonly occur. Eventually, the patient develops a characteristic dull, expressionless face and edema of the face, hands, and feet.
Also, deep tendon reflexes are delayed, and bradycardia and abdominal distention may occur.
Uterine fibroids.Menorrhagia is the most common sign of uterine fibroids, but other forms of abnormal uterine bleeding as well as dysmenorrhea or leukorrhea can also occur. Possible related findings include abdominal pain, a feeling of abdominal heaviness, a backache, constipation, urinary urgency or frequency, and an enlarged uterus, which is usually nontender.
Other causes
Drugs.The use of a hormonal contraceptive may cause a sudden onset of profuse, prolonged menorrhagia. Anticoagulants have also been associated with excessive menstrual flow. Injectable or implanted contraceptives may cause menorrhagia in some women.
Intrauterine devices.Menorrhagia can result from the use of intrauterine contraceptive devices.
Nursing considerations
▪ Monitor the patient's vital signs and observe closely for signs of hypovolemia.
▪ Encourage the patient to maintain an adequate fluid intake, insert an I.V. catheter for fluid or blood administration.
▪ Monitor intake and output, and estimate uterine blood loss by recording the number of sanitary napkins or tampons used during an abnormal menses and comparing this with usage during a normal menses.
▪ Obtain blood samples for hematocrit, prothrombin time, partial thromboplastin time, and International Normalized Ratio levels.
Patient teaching
▪ Explain all procedures and treatments to the patient.
▪ Discuss the need to rest and to avoid strenuous activities until bleeding subsides.
▪ Teach signs and symptoms that require immediate medical attention.
Book Source Details
- Book Title: Nursing: Interpreting Signs and Symptoms
- Author(s): Springhouse
- Year of Publication: 2007
- Copyright Details: Nursing: Interpreting Signs and Symptoms, Copyright © 2007 Lippincott Williams & Wilkins.
Other Book Chapters Related to Menorrhagia
Read excerpts from these other book chapters related to Menorrhagia:
Medical Books Excerpts
- Dysmenorrhea
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
- [ read ]
- Metrorrhagia
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
- [ read ]
- Menorrhagia
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
- [ read ]
- Dysmenorrhea
- "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
- [ read ]
- Menorrhagia
- "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
- [ read ]
Copyright Details: Nursing: Interpreting Signs and Symptoms, Copyright © 2008 Williams & Wilkins.
More About Causes of Menorrhagia
» Next page: DYSMENORRHEA (Differential Diagnosis in Primary Care)
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