Symptom Finder - Hypermenorrhea
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.
Case Presentation #49
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.
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.
Case Presentation #49
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.
