Treatment of frequent or heavy bleeding

1. Treatment with nonsteroidal anti-inflammatory drugs (NSAIDs) improves platelet aggregation and increases uterine vasoconstriction. NSAI Ds are the first choice in the treatment of menorrhagia because they are well tolerated and do not have the hormonal effects of oral contraceptives.

a. Mefenamic acid (Ponstel) 500 mg tid during the menstrual period.

b. Naproxen (Anaprox, Naprosyn) 500-mg loading dose, then 250 mg tid during the menstrual period.

c. Ibuprofen (Motrin, Nuprin) 400-600 mg tid during the menstrual period.

d. Gastrointestinal distress is common, and NSAIDs are contraindicated in renal failure and peptic ulcer disease.

2. Iron should also be added as ferrous gluconate 325 mg tid.

H. Patients with hypovolemia or a hemoglobin level below 7 g/dL should be hospitalized for hormonal therapy, iron replacement, and possibly transfusion.

1. Hormonal therapy consists of estrogen (Premarin) 25 mg IV q6h until bleeding stops. Thereafter, oral contraceptive pills should be administered q6h x 7 days, then taper slowly to one pill qd.

2. If bleeding continues, IV vasopressin (DDAVP) should be administered. Hysteroscopy may be necessary, and dilation and curettage is a last resort.

3. Iron should also be added as ferrous gluconate 325 mg tid. IV. Primary childbearing years--ages 16 to early 40's

A. Contraceptive complications and pregnancy are the most common causes of abnormal bleeding in this age group. Anovulation accounts for 20% of cases.

B. Adenomyosis, endometriosis, and fibroids increase in frequency as a woman ages, as do endometrial hyperplasia and endometrial polyps. Pelvic inflammatory disease and endocrine dysfunction may also occur.

Cure Tennis Elbow Without Surgery

Cure Tennis Elbow Without Surgery

Everything you wanted to know about. How To Cure Tennis Elbow. Are you an athlete who suffers from tennis elbow? Contrary to popular opinion, most people who suffer from tennis elbow do not even play tennis. They get this condition, which is a torn tendon in the elbow, from the strain of using the same motions with the arm, repeatedly. If you have tennis elbow, you understand how the pain can disrupt your day.

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