Normally in each menstrual cycle 40-70 ml of bleeding occurs. Normally blood clots are also absent.
Menorrhagia is defined , if in cyclical bleeding at normal intervals , excessive bleeding of more than 80 ml occurs or cycle is of excessive duration or if both occurs. Menotaxis is a term used to define prolonged bleeding.

Medchrome Women's Health

Causes:
Organic:
Pelvic cause- Fibroid uterus ( Myoma), Adenomyosis, Pelvic endometriosis, Chronic tubo-ovarian mass, IUCD in utero, Tubercular endometritis, Retroverted gravid uterus, Granulosa cell tumor of Ovary.
Systemic- Liver failure, Congestive cardiac failure, Severe hypertension.
Endocrinal- Hypothyroid and Hyperthyroid states.
Blood dyscrasias: ITP, Leukemia, von-Willebrand’s disease.
Emotional upset- Functional component.

Commonest causes are:-
• DUB- Dysfunctional Uterine Bleeding
• Fibroid
• Adenomyosis
• Chronic tubo-ovarian mass

Treatment:
According to the Cause

Causative Organism and Transmission-

It is caused by a protozoan called Trichomonas vaginalis which is 20 micrometer X 10 micrometer pear shaped parasitic organism. It has 4 anterior flagellae and a spear-like protrusion at the other end . It is covered by an undulating membrane on its anterior 2/3^rd. It is actively motile organism.

Predominantly transmitted by sexual contact. Urethra and prostrate of Male ( men) harbors the trichomonas and may even be transmitted via toilet articles from women-women or via examining gloves of a health personnel.

Incubation period is 3-28 days.

Pathology-

25% of women in reproductive age group have asymptomatic infection. When local defence mechanisms are impaired during menstruation, following illness or sexual activity, the pH of vagina is raised to 5.5-6.5. Trichomonas infectio

n can thus occur at this pH. They produce inflammatory

reaction.

75% organism can be isolated from Urethra, Skene’s tubules and Bartholin’s gland .

Clinical Features-

1. There is profuse, offensive vaginal discharge ( usually following menstruation)
2. Itching and Irritation mild to severe around the genitalia
3. Urinary symptoms like dysurea ( painful urination), frequency of urination can occur
4. History of similar attacks in past may be derieved
5. Up to one-third of infected women have no symptoms

Men

• The majority of infected men have no symptoms
• Urethral discharge,Pain with urination – dysurea
• Pain and swelling in the scrotum

On Examination-

• Thin, froathy, greenish to yellow, offensive discharge per vaginum
• The vulva is inflamed, Evidence of pruritis like scratch marks, abrasions, redness may be seen.
• Per vaginal examination may be painful, red inflamed walls with punctuate hemorrhages can be seen. Similar lesions may also be seen  over the PortioVaginalis part of Cervix and may be “ Strawberry” appearance.

Diagnosis-

• Identification is done by Hanging drop preparation. Motile organisms may be found. If negative on repeated examinations, culure should be done for confirmation.
• Culture of the discharge collected by swabs in Kupfberg’s or Fein Whittington medium.

D/D- Gonorrhea, Candidiasis.

Treatment-

1. Metronidazole is quiet effective for the treatment. 200mg TDS PO for 1 week is given. Partner should be treated at the same time and for same duration. Barrier methods of contraception should be used until cured. A second course of therapy may be required if the symptoms persist after 7 days. Upto 3 cycles in 3 months may be needed.Use of Metronidazole in Pregnancy  can cause teratogenic effects on fetus ( congenital malformations).
2. Clotrimazole pessaries 100mg for consecutive 6 nights. It is preferred during pregnancy and lactation. It treats candidiasis as well.

More Readings at- Simplified Trichomoniasis ,Patients’s Reading

Medchrome Women's Health

LOADING DOSE

• Take 4 gm MgSO4 IV as 20% solution
• Take one 20ml syringe
• Draw 4 ampules of MgSO4 50%= 8ml= 4gm into the syringe
• Add 12 ml water for inj to make it 20%
• Give IV slowly over 5 minutes
Follow promptly with 10 gm as 50% MgSO4 deep IM
• Take two 10ml syringes
• Draw 5 amp of MgSO4 50% =10ml =5gm into each syringe
• Add 1 ml of 2% Lignocaine in each syringe
• Give deep IM in each buttock
• If further fits occur, give further 2 amp of MgSO4 50% =4ml =2gm IV slowly over 5 minutes
MAINTENANCE DOSE:
• 5gm as 50% MgSO4 deep IM in alternate buttocks every 4 hrly
• Take one 10ml syringe
• Draw 5 amp of MgSO4 50% =10ml =5gm into the syringe
• Add 1 ml of 2% lignocaine in that syringe
• Give deep IM in alternate buttocks every 4 hrly
• Continue same treatment for 24 hrs after delivery or the last convulsion, whichever is the last

BEFORE REPEATING MgSO4 ALWAYS monitor for toxicity. Withhold or delay if any of the following
• Respiratior rate <16/min
• Patellar reflexes absent
• Urine output < 30ml/hr

If respiratory arrest:
• Assist ventilation with bag and mask or intubation
• Give calcium gluconate 1 gm ( 10ml of 10%) IV slowly until respiration begins.

Source: USAID and ACCESS

Please for Study purpose only, This is not a medical advice or prescription

Medchrome Women's Health

TLC and Discover Health both have aired the now extremely popular show “I Didn’t Know I was Pregnant.” The show, which features two or more women who endure the entire term of their pregnancy without knowing they were expecting at all. The popularity of this particular show is perhaps yet another extension of well-received reality, health-based shows like Obsessed, which features patients having strange, clinically diagnosed obsessions.

The entertainment of these shows aside, how rare is it to not know you may be expecting?

According to Dr. Kristin Bendrikson, an assistant professor of obstetrics and gynecology at the University of Southern California, being unaware of a pregnancy is extremely rare, but it isn’t particularly surprising in women who are either already overweight when they conceive, or if they happen to have very irregular or erratic periods.

There are two types of women who may be plagued by irregular periods. On the one hand, a young woman can have what is called polycystic ovarian syndrome. PCOS is one of the most common endocrine disorders affecting women–approximately 5%-10% of women aged 12-45 years old have the disorder. On the other hand, women who are experiencing a phase of perimenopausal transition are also subject to unnoticed pregnancies. Perimenopause occurs a few years before and after the final period, in which periods are light and erratic. In both instances, women may dismiss a missed period, or they may have light spotting throughout the pregnancy and mistaken that for an actual period.

A highly critical Time Magazine article about the TLC/Discovery Health Show demonstrates the more adverse effects the show may have on the popular imagination. The article notes:

 ”The cult of pregnancy today requires a lot of self-denial. Women are advised to avoid alcohol and cigarettes as well as deli meat, sushi, coffee and a million other pleasures. But the women of I Didn’t Know I Was Pregnant didn’t deny themselves anything during those nine months, had few if any symptoms and still wound up with perfect-looking babies!”

While producers of the show insist that this was not their intention, it is very important for women who are sexually active–whether or not they are on birth control–to be constantly aware of the possibility, however slim, of pregnancy. While the show always ends happily, an unexpected pregnancy in real life isn’t always so convenient. The most important thing is to be always aware of even the slightest changes in your body.

By-line:

This guest post is contributed by Tisha Dotson, who writes on the topics of medical coding certification.  She welcomes your comments at her email Id: tishadotson86@gmail.com.