الفهرس 
MenorrhagiaOnly 14 pages are availabe for public view
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Abstract
Dysfunctional uterine bleeding (DUB) is defined as abnormal bleeding from the uterus in the absence of an organic disease.
Menorrhagia is defined as excessive and/or prolonged loss of blood on a regular cyclical basis or objectively as menstrual blood loss of
>80 ml for the whole period. in dysfunctional menorrhagia, there is No organic cause. approximately 10% of women of reproductiveage group suffer from excessive menstrual blood loss.
Menorrhagia constitutes a considerable problem for many women, causing discomfort, anxiety and disruption to women’s quality of life. it is the most common cause of iron deficiency anemia in women of reproductive age.
Dysfunctional uterine bleeding (DUB) exerts a significant burden on society. A large proportion of women presenting for treatment of excessive menstruation have monthly blood loss within the normal range but still request help.
Menorrhagia can be caused by pelvic pathology such as myomata, adenomyosis, endometriosis, endometrial polyps, polycystic ovarian disease, endometrial carcinoma and uterine vascular malformations. This type of menorrhagia is classified as organic menorrhagia. In addition, menorrhagia can present as a symptom without the presence of local pelvic pathology and so called dysfunctional menorrhagia, which is can be primary, where there is neither disease of the genital tract nor other disease responsible for the bleeding or iatrogenic causes such as sex hormone administration or Secondery dysfunctional menorrhagia occurs due to use of such agents as sex hormones , IUDs or secondary to organic systemic disease outside the genital tract.
Medical therapy of dysfunctional uterine bleeding is often successful but recurrence is frequent. Unfortunately, prolonged medical treatments unpractical because of poor patient compliance, side effects and costs of drugs.
Progestagents are the most frequently prescribed drugs for the treatment of dysfunctional uterine bleeding. Data support their use in anovulatory women but a number of comparative trials have shown that an overall reduction in blood loss of only 20% is achieved in ovulatory women. Combined oral contraceptives were at one time popular but whether the low-dose current generation pills are equally effective in awaits appropriate trials. Prostaglandin syntheses inhibitors can be useful, with up 30% of the women complaining of menorrhagia can benefit from a reduction of the menstrual blood loss between 25% and 35% as before their use. A proportionally greater reduction is seen in women with more excessive bleeding .
Antifibrinolytic drugs have been shown to reduce menstrual blood loss in dysfunctional uterine bleeding by 50%and would be useful in women in whom estrogens are contraindicated.
Gonadotropin – releasing hormones analogous are highly effective because of their ability to induce amenorrhea but long-term use is contraindicated because of their hypo-estrogenic effects. Some trials on gestrinone in dose of 2.5 mg twice weekly in menorrhagic patients have shown successful results.
One other effective therapy for menorrhagia is danazol. At a dosage of 200 mg daily, danazol has been shown to be highly effective in several open and randomized comparative trials, with a consistent reduction of blood loss of 75% being achieved by with maintenance of regular menstrual cycle.
A new modality of therapy for menorrhagia is the levonorgestreal-releasing intrauterine system (LNS-IUS) the original LNG IUD has been developed by leiras pharmaceuticals Turku, finland in 1990. it releases 20 ug levonorgestrel per day and called levo-Nova. It received licensing approval in the united kingdom in 1995 under the name of MIRENA. Locally it is modified by Azzam in (1994) under the name of metraPlant, it has the double the surface area and 50% of the concentration as the dose the original Levo-Nova. It releases about 20 ug daily for up to five years.
Contraception is provided, fertility may be restored at any time, the cost is limited and the need for subsequent hysterectomy is reduced. Furthermore, blood progestin levels are lower than those observed after orally or parenterally administered doses; therefore, the drug related side effects should be less.
The primary end point was the degree of reduction of monthly bleeding in subjects in the treatment group at 1, 3,6 months of follow up. Patient’s satisfaction and health-related quality life were also evaluated.
The study was carried out in El-Helal Hospital Sohag, Upper Egypt to evaluate Metrat plant as regard to decrease MBL and increased body iron stores, the study stanted at March 2009 till December 2009.
30 subjects 29-52 years old, were allocated to (metraplant), the study showed that 3 females remove metraplant 2 case for desire to get pregnant and the other for sporting bleeding.
Histopathology before application metraplant 7 case is under progesterone effect 5 case is prolifentive endometium 2 cassis predates and conception 2 cases hyperplasia disorder 4 cases atrophic endometrium.