[Meno-metrorrhagia]

Abstract

Menometrorrhagia is frequent. It consists in menorrhagia (excessive menstrual flow and duration) and metrorrhagia (irregular, excessive flow and duration). Three different types of aetiology occur: general extra-gynaecological causes, endocrine causes and organic causes. This last group is made of myomas, polyps, endometrial hyperplasia, adenomyosis and uterine cancers. Dysfunctional uterine bleedings do not find their cause in one of these three main causes. The diagnosis is based on three types of complementary investigations: endo-uterine cytological and histological samplings, medical imaging of which endovaginal echography is the most accurate, and diagnostic hysteroscopy. This triad allows to reach a very precise diagnosis in order to exclude a malignant lesion. Thanks to this precise diagnosis, the therapeutic decision is made according to the nature of the lesion to be treated, the desire to retain fertility, and age. Medical and surgical treatments are possible. In most cases of general extra-gynaecological and endocrine causes, medical treatment is efficient and etiological. When organic uterine lesions are present, several medical treatments are efficient by suppressing the cause of bleeding or by symptomatic action. Main medical treatments are: anti-fibrinolytic agents, nonsteroidal anti-inflammatory drugs, progestin, oral contraceptive pills, GnRH agonists and danazol. The surgical treatment consists in endoscopic techniques (operative hysteroscopy and laparoscopy) and hysterectomy performed by vaginal route with or without laparoscopic preparation, by laparoscopic approach only or by classical laparotomy. Currently, the classical D & C has become essentially a diagnostic method. Surgical treatment is necessary after failure of a medical treatment or in the presence of a lesion not directly accessible to medical therapy. The efficacy of conservative endoscopic techniques depends on the respect of the indications of these techniques. These allow to reduce the number of hysterectomies for benign lesions by up to 50%.