شرح المدرسين
Summary
Metrorrhagia, or intermenstrual bleeding, is defined as irregular vaginal bleeding occurring outside of the expected menstrual period, varying from light spotting to heavy flow. Key symptoms include unexpected bleeding of varying color and intensity, often accompanied by pelvic pain, bloating, headaches, and fatigue. Common causes range from hormonal imbalances, contraceptive use, and uterine structural issues like fibroids or polyps, to pregnancy-related complications, certain medications, stress, and, in rarer cases, neoplasia. Management strategies depend on the cause and can involve medical treatments like hormonal therapy, NSAIDs, tranexamic acid, and iron supplements, or surgical interventions such as Dilation and Curettage (D&C), endometrial ablation, myomectomy, uterine artery embolization, hysteroscopic polypectomy, or hysterectomy, chosen based on the bleeding's cause, severity, and the patient's desire for future fertility.
Overview
Definition: Commonly called intermenstrual bleeding, is vaginal bleeding that occurs at irregular intervals not associated with the menstrual cycle. The bleeding may range from light spotting to heavier-than-normal flow and can occur occasionally or persistently.
It differs from:
Note
ملاحظة
Symptoms of Metrorrhagia
Main symptoms
- Bleeding or spotting at unexpected times in the menstrual cycle
- Bleeding may range from light spotting to a flow heavier than normal menstruation
- Color of blood can vary from dark brown to bright red
Associated Symptoms:
- Lower abdominal or pelvic pain
- Bloating
- Headaches
- Fatigue or weakness (especially with heavy or chronic bleeding)
- Passage of blood clots or mucus
Common Causes of Metrorrhagia:
- Hormonal Imbalances.
- Hormonal Contraceptives
- Uterine Structural Issues (e.g., Fibroids, Endometrial polyps, Adenomyosis)
- Pregnancy Related (e.g., Implantation bleeding, Miscarriage, Ectopic pregnancy)
- Infections (e.g., Pelvic inflammatory disease (PID), Cervicitis)
- Medical Conditions (e.g., PCOS, Hypo/hyperthyroidism, Coagulopathies)
- Neoplasia
- Medications (e.g., Anticoagulants (warfarin, aspirin), steroid)
- Stress
Managment
Medical Management
| Treatment | Indications |
|---|---|
| Hormonal Therapy | Oral contraceptives, progestins, or levonorgestrel IUD to regulate cycles and reduce bleeding |
| NSAIDs | Reduce menstrual flow and pain |
| Tranexamic Acid | Antifibrinolytic that reduces heavy bleeding |
| Desmopressin | For patients with mild bleeding disorders |
| Iron Supplements | To treat or prevent iron-deficiency anemia due to chronic blood loss |
Surgical or Interventional Procedures
| Procedure | Indications |
|---|---|
| Dilation and Curettage (D&C) | Diagnostic and therapeutic for abnormal bleeding |
| Endometrial Ablation | Destroys uterine lining; for women not desiring future fertility |
| Myomectomy | Surgical removal of fibroids while preserving uterus |
| Uterine Artery Embolization (UAE) | Minimally invasive; used to shrink fibroids |
| Hysteroscopic Polypectomy | Removal of endometrial polyps |
| Hysterectomy | Definitive treatment for recurrent or refractory bleeding; especially if malignancy is a concern |
احصل على التجربة الكاملة
اشترك للوصول لفيديوهات الشرح التفصيلي والبطاقات التعليمية التفاعلية وأسئلة الممارسة مع تتبع التقدم.