FOR BSC NURSING STUDENTS

1. METRORRHAGIA
NITISH SINGH
ASST. PROF.
M.K.S.N AZAMGARH

2. • Metrorrhagia, now commonly called
intermenstrual bleeding, is vaginal
bleeding that occurs at irregular
intervals not associated with
the menstrual cycle.
METRORRHAGIA

3. Menstrual Period Characteristics
Normal Abnormal
Duration 4-6 days <2d, >7d
Volume 30-35cc >80cc
Cycle length 21-35d <21d, >35d
Average Iron loss: 16mg

4. 4
Menstrual
Abnormalities
Amenorrhea
Dysmenorrhea
Menorrhagia
Oligomenorrhea
Menometrorrhagia
Metrorrhagia
Absence of menstruation
Painful cramping
Prolonged bleeding
> 7 days or > 80 cc
occurring at regular intervals Cycles longer than 6-7 weeks
Irregular and excessive
bleeding during or between
periods
Bleeding between periods
Polymenorrhea
Cycles shorter than 3 weeks

5. CAUSES
There are many potential causes of metrorrhagia,
though in most cases hormone levels play a key role.
During a regular menstrual period, hormonal
changes direct the lining of the uterus to build up in
preparation to receive and nourish a fertilized egg. If
this does not occur, the lining is shed and passes
through the vagina.

6. CAUSES CONT…
– STRESS
– BIRTH CONTROL MEDICATION
– MALNOURISHMENT
– FERTILITY TREATMENT
Metrorrhagia can occur in people with:
Uterine inflammation (endometritis)
Cervical inflammation (cervicitis)
Vaginal inflammation (vaginitis)
Pelvic inflammatory disease
Sexually-transmitted infections
Endometriosis
Polycystic ovarian syndrome (PCOS)

7. SIGN AND SYMPTOMS
When bleeding occurs outside the expected timeframe of the
menstrual cycle, it is sometimes referred to as abnormal or
dysfunctional uterine bleeding.
Some people who menstruate regularly experience light
bleeding or spotting at various times throughout their cycle,
especially at ovulation. In these cases, symptoms such as mild
discomfort and spotting at mid-cycle, may not be unusual for a
person.

8. Sign cont…
Intermenstrual bleeding is often light, but can also be
quite heavy. In some cases, it may even be heavier
than your regular period.
The color of the blood can range from dark brown to
red to light pink. Some people may see clots or mucus
in their underwear or when they wipe.

9. Diagnostic Evaluation
•Blood tests to check for disorders that cause bleeding,
nutritional deficiencies, infections, m[arkers of inflammation,
and other findings
•Tests to check your hormone levels and thyroid function
•Urine samples to check for pregnancy, infection, or STDs
•Ultrasounds of your abdomen and pelvis, including transvaginal
ultrasounds
•CT scans or MRIs
•Pap smear to test for cervical cancer

10. MANAGEMENT

11. • Source of bleeding (vagina ,urethra or rectum?)
• excessive bleeding is assessed by number of pads used, passage of clots (size and number), and duration of
bleeding.
• pattern of bleeding
 Period not predictable & irregular – could be ovulatory dysfunction (2ry to PCOS or peri-menopausal
anovulation
 Intermenstrual bleeding – Anatomic source (submucosal fibroids or uterine polyp)
 Always had very heavy period – Could be coagulopathy
• assess the blood loss by admitting the patient during period.
• Any emotional upset or psychosexual problem should be elicited tactfully
• Use of steroidal contraceptives or IUCD insertion should be enquired.
• History of abnormal bleeding from the injury site, epistaxis, gum bleeding, or that suggestive of PID should be
enquired.
HISTORY

12. LAB EVALUATION
A complete blood count (CBC) is recommended for women with AUB to
look for anemia
It is recommended to perform a sensitive urine pregnancy test whenever
indicated, or if pregnancy is suspected.
Bleeding time, platelet count, prothrombin time, and partial thromboplastin
time are recommended in all adolescents and in adults with a positive
screen for coagulopathies. Further testing for von Willebrand disease,
ristocetin cofactor activity, factor VIII activity, and von Willebrand factor
antigen is recommended in consultation with a hematologist.
TSH test is done when clinically indicated

13. HOW TO
TREAT ?
I. General
II. Medical
III.Surgical intervention

14. Rest is advised during bleeding phase. Assurance and sympathetic
handling are helpful particularly in adolescents. Anemia should be
corrected energetically by diet, hematinics, and even by blood
transfusion.
General

15. Lifestyle Changes
In some cases, the condition may be temporary and responsive to
changes in your lifestyle. You may be able to treat discomfort with
over-the-counter pain relievers (such as NSAIDs) while you work on
reducing stress or getting yourself back on a routine after a vacation,
for example. If you are underweight, you may notice your symptoms
improve when you begin to regain weight.

16. Some people decide to use different types of hormonal
therapy, especially progestin, to treat abnormal bleeding.
These can include birth control pills, IUDs, estrogen patches,
and other options. Another form of therapy
called Gonadotropin-releasing hormone (GnRH) agonists may
also be prescribed. However, these medications can only be
used short-term and can have many side effects.
If you are not sexually active or have never had sex, you can
still use hormonal methods to treat problems with your
menstrual cycle. Your doctor will help you decide which one is
best for you.
Hormonal Therapy

17. Procedures like dilation and curettage (D & C) may be recommended if you
have heavy bleeding that is causing other problems, like anemia. You don't
necessarily need to go to the hospital for a D&C—the procedure can often
be done in a doctor's office or at a reproductive health clinic.
Although D&C is not surgery per se, it is typically performed while you are
under anesthesia. While it can be useful for figuring out why you are
bleeding abnormally, D&C procedures don't solve the problem indefinitely.
They are also more invasive than other options and come with their own
risks. Your doctor will help you decide if it's the appropriate option for you.
Dilation and Curettage

18. Thank You