Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Gynaecology > 1: Menstruation: Dysfunctional Uterine Bleeding, Menorrhagia, Dysmenorrhoea > Flashcards

1: Menstruation: Dysfunctional Uterine Bleeding, Menorrhagia, Dysmenorrhoea Flashcards

1
Q

What is dysfunctional uterine bleeding now referred to

A

Abnormal Uterine Bleeding (AUB)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is dysfunctional uterine bleeding now referred to

A

Abnormal Uterine Bleeding (AUB)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Define abnormal uterine bleeding

A

Abnormal genital tract bleeding in absence of systemic, genital tract pathology or pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What can abnormal uterine bleeding include in presentation

A
  • IM Bleeding
  • Post-coital bleeding
  • Post-menopausal bleeding
  • Heavy menstural bleeding
  • More than 7-9d difference between cycle length
  • Cycle <24d or >38d
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

When should abnormal uterine bleeding only be used

A

AUB is a diagnosis of exclusion and should only be made when other pathology has been excluded

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

According to FIGO how can causes of AUB be divided

A
  1. Structural

2. Non-structural

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is a menumonic to remember structural causes of AUB

A

PALM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are structural causes of AUB

A

Polyps
Adenomyosis
Leiomyomas
Malignancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is a mnemonic to remember non structural causes of AUB

A

COIEN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the non-structural causes of AUB

A 
Coagulopathies 
Ovulatory dysfunction
Iatrogenic 
Endometrial 
Not yet classified
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the main symptom of AUB

A

Menorrhagia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What % of women with menorrhagia have AUB

A

50-60% women with DUB will have menorrhagia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the commonest symptom of dysfunctional uterine bleeding

A

Menorrhagia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Define menorrhagia

A

Heavy menstrual bleeding that impacts a women quality of life

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Explain the old definition of menorrhagia and problem with this

A

It used to be defined as >80ml blood loss per cycle. However, this could not be measured

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What % women suffer with menorrhagia

A

3%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is 60% of menorrhagia caused by

A

DUB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are 7 causes of menorrhagia

A
  1. DUB
  2. IUD
  3. Hypothyroidism
  4. Coagulopathies
  5. Fibroids
  6. Adenomyosis
  7. Endometriosis
  8. Pelvic infection
  9. Polyps
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the most common coagulation disorder to cause menorrhagia

A

Von Wille brand disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

If a women >45 has menorrhagia what should be suspected

A

Endometrial cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Explain presentation of menorrhagia

A

Heavy or prolonged menstrual bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Why may a women with menorrhagia present to health care

A

Change in periods or impact on QOL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are associated symptoms of menorrhagia

A

Anaemia: pale, breathlessness, fatigue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What may enlarged uterus and menorrhagia indicate

A

Fibroids, adenomyosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
At the bedside, what should all women with menorrhagia have
Pregnancy test
26
What are two other bedside tests for menorrhagia
STI | Cervical smear
27
What are 3 blood tests for menorrhagia
FBC Coagulation screen TFTs
28
When is a coagulation screen performed
If suspect coagulopathy: easy bruising, gum bleeding
29
Explain investigation in women under 45-years
Women under 45, need no further investigation of menorrhagia as there is a low risk of endometrial pathology
30
Explain investigation in women over 45-years for menorrhagia
Women over 45 should be investigated - due to increased risk of endometrial cancer
31
When is TV-US indicated
Women over 45 with menorrhagia, IM bleeding, Post-menopausal bleeding
32
When is pipette endometrial biopsy performed
Menorrhagia resistant to pharmacological management
33
When is hysteroscopy and endometrial biopsy performed
Abnormality (endometrial thickening) found on TV-US
34
How should menorrhagia be managed if underlying cause
treat underlying cause
35
If no treatable underlying pathology, what is first-line for menorrhagia
levonorgestrel-releasing system (IUS)
36
Name a levonorgestrel-releasing system
Mirena Coil
37
What is the role of mirena coil
Releases progesterone - causes thinning of the endometrium. Also can be used as a contraceptive
38
How long can mirena coil be kept in
5-years
39
What are SE of mirena coil
Irregular bleeding in first 4-6m
40
What is second-line for menorrhagia
Mefenamic acid Tranexamic acid COCP
41
What does choice between tranexamic acid, mefenamic acid and cocp depend on
- Women's choice about wanting to conceive | - Presence of dysmenorrhoea
42
What is the MOA of tranexamic acid
Anti-Fibrinolytic
43
How is tranexamic acid taken
PO up to 4d during bleeding
44
When is tranexamic acid preferred
If not trying to conceive - as it is non-hormonal
45
What is mefanamic acid
NSAID
46
How is mefenamic acid taken
During bleeding
47
When is mefenamic acid most useful
If associated dysmenorrhoea - as it also has analgesic properties
48
What is problem with COCP as second-line
Cannot be used if women is trying to conceive
49
What is third-line for menorrhagia
Oral northisterone
50
What is oral northisterone a type of
Progesterone
51
explain how oral norhisterone is taken for menorrhagia
Taken for 5-7 days during the cycle
52
what is the problem with northisterone in menorrhagia
It is not effective as a contraceptive when taken for 5-7d
53
what can be given as alternative to oral northisterone
Depo or Implant
54
what can be used as last-line for management of menorrhagia
Surgery
55
when is surgery for menorrhagia indicated
Medical-treatment failed
56
what are the two main types of surgery for menorrhagia
Endometrial ablation | Hysterectomy
57
what is the main surgery for menorrhagia
Endometrial ablation
58
what is endometrial ablation
Uses diathermy to remove endometrium
59
when is endometrial ablation used
Women who do not want to conceive
60
what do women need to continue after endometrial ablation and why
Contraception - as women is still ovulating and if fertilised increases risk of ectopic pregnancy
61
what is the definitive treatment for menorrhagia
Hysterectomy
62
what is sub-total hysterectomy
Removal of uterus | Cervix remains intact
63
what is total hysterectomy
Removal uterus and cervix
64
Define abnormal uterine bleeding
Abnormal genital tract bleeding in absence of systemic, genital tract pathology or pregnancy
65
What can abnormal uterine bleeding include in presentation
- IM Bleeding - Post-coital bleeding - Post-menopausal bleeding - Heavy menstural bleeding - More than 7-9d difference between cycle length - Cycle <24d or >38d
66
When should abnormal uterine bleeding only be used
AUB is a diagnosis of exclusion and should only be made when other pathology has been excluded
67
According to FIGO how can causes of AUB be divided
1. Structural | 2. Non-structural
68
What is a menumonic to remember structural causes of AUB
PALM
69
What are structural causes of AUB
Polyps Adenomyosis Leiomyomas Malignancy
70
What is a mnemonic to remember non structural causes of AUB
COIEN
71
What are the non-structural causes of AUB
``` Coagulopathies Ovulatory dysfunction Iatrogenic Endometrial Not yet classified ```
72
What is the main symptom of AUB
Menorrhagia
73
What % of women with menorrhagia have AUB
50-60% women with DUB will have menorrhagia
74
What is the commonest symptom of dysfunctional uterine bleeding
Menorrhagia
75
Define menorrhagia
Heavy menstrual bleeding that impacts a women quality of life
76
Explain the old definition of menorrhagia and problem with this
It used to be defined as >80ml blood loss per cycle. However, this could not be measured
77
What % women suffer with menorrhagia
3%
78
What is 60% of menorrhagia caused by
DUB
79
What are 7 causes of menorrhagia
1. DUB 2. IUD 3. Hypothyroidism 4. Coagulopathies 5. Fibroids 6. Adenomyosis 7. Endometriosis 8. Pelvic infection 9. Polyps
80
What is the most common coagulation disorder to cause menorrhagia
Von Wille brand disease
81
If a women >45 has menorrhagia what should be suspected
Endometrial cancer
82
Explain presentation of menorrhagia
Heavy or prolonged menstrual bleeding
83
Why may a women with menorrhagia present to health care
Change in periods or impact on QOL
84
What are associated symptoms of menorrhagia
Anaemia: pale, breathlessness, fatigue
85
What may enlarged uterus and menorrhagia indicate
Fibroids, adenomyosis
86
At the bedside, what should all women with menorrhagia have
Pregnancy test
87
What are two other bedside tests for menorrhagia
STI | Cervical smear
88
What are 3 blood tests for menorrhagia
FBC Coagulation screen TFTs
89
When is a coagulation screen performed
If suspect coagulopathy: easy bruising, gum bleeding
90
Explain investigation in women under 45-years
Women under 45, need no further investigation of menorrhagia as there is a low risk of endometrial pathology
91
Explain investigation in women over 45-years for menorrhagia
Women over 45 should be investigated - due to increased risk of endometrial cancer
92
When is TV-US indicated
Women over 45 with menorrhagia, IM bleeding, Post-menopausal bleeding
93
When is pipette endometrial biopsy performed
Menorrhagia resistant to pharmacological management
94
When is hysteroscopy and endometrial biopsy performed
Abnormality (endometrial thickening) found on TV-US
95
How should menorrhagia be managed if underlying cause
treat underlying cause
96
If no treatable underlying pathology, what is first-line for menorrhagia
levonorgestrel-releasing system (IUS)
97
Name a levonorgestrel-releasing system
Mirena Coil
98
What is the role of mirena coil
Releases progesterone - causes thinning of the endometrium. Also can be used as a contraceptive
99
How long can mirena coil be kept in
5-years
100
What are SE of mirena coil
Irregular bleeding in first 4-6m
101
What is second-line for menorrhagia
Mefenamic acid Tranexamic acid COCP
102
What does choice between tranexamic acid, mefenamic acid and cocp depend on
- Women's choice about wanting to conceive | - Presence of dysmenorrhoea
103
What is the MOA of tranexamic acid
Anti-Fibrinolytic
104
How is tranexamic acid taken
PO up to 4d during bleeding
105
When is tranexamic acid preferred
If not trying to conceive - as it is non-hormonal
106
What is mefanamic acid
NSAID
107
How is mefenamic acid taken
During bleeding
108
When is mefenamic acid most useful
If associated dysmenorrhoea - as it also has analgesic properties
109
What is problem with COCP as second-line
Cannot be used if women is trying to conceive
110
What is third-line for menorrhagia
Oral northisterone
111
What is oral northisterone a type of
Progesterone
112
explain how oral norhisterone is taken for menorrhagia
Taken for 5-7 days during the cycle
113
what is the problem with northisterone in menorrhagia
It is not effective as a contraceptive when taken for 5-7d
114
what can be given as alternative to oral northisterone
Depo or Implant
115
what can be used as last-line for management of menorrhagia
Surgery
116
when is surgery for menorrhagia indicated
Medical-treatment failed
117
what are the two main types of surgery for menorrhagia
Endometrial ablation | Hysterectomy
118
what is the main surgery for menorrhagia
Endometrial ablation
119
what is endometrial ablation
Uses diathermy to remove endometrium
120
when is endometrial ablation used
Women who do not want to conceive
121
what do women need to continue after endometrial ablation and why
Contraception - as women is still ovulating and if fertilised increases risk of ectopic pregnancy
122
what is the definitive treatment for menorrhagia
Hysterectomy
123
what is sub-total hysterectomy
Removal of uterus | Cervix remains intact
124
what is total hysterectomy
Removal uterus and cervix
125
define dysmenorrhoea
painful periods
126
how can dysmenorrhoea be categorised
- Primary dysmenorrhoea | - Secondary dysmenorrhoea
127
what is primary dysmenorrhoea
Painful periods with no underlying pelvic abnormality
128
what is secondary dysmenorrhoea
Painful periods with underlying pelvic pathology
129
when does primary dysmenorrhoea tend to occur
Earlier in life - as no associated pelvic conditions
130
when does secondary dysmenorrhoea tend to occur
Later in life
131
what are 5 causes of secondary dysmenorrhoea
1. Fibroids 2. Adenomyosis 3. Pelvic Adhesions 4. Asherman's syndrome 5. PID 6. LLETZ causing cervical stenosis
132
give 5 risk factors for primary dysmenorrhoea
1. Nulliparous 2. Early menarche 3. Dysmenorrhoea 4. Long menstrual phase 5. Smoking
133
Explain clinical presentation of primary dysmenorrhoea
- Crampy lower abdominal pain that may radiate to the back or anterior thigh
134
How long dose primary dysmenorrhoea last
- Worse at the onset of periods | - Each episode may last 48-72h
135
What can primary dysmenorrhoea be associated with
- Nausea - Vomiting - Dizziness
136
How does secondary dysmenorrhoea present
- More constant pain | - Associated with deep dyspareunia
137
What is primary dysmenorrhoea as a differential
Primary dysmenorrhoea is a differential of exclusion - hence secondary causes should be identified and managed first
138
Explain pathophysiology of primary dysmenorrhoea
- If the ova is not fertilised to corpus luteum will regress - This will cause a drop in progesterone and oestrogen - Drop in progesterone causes endometrial cells to secrete prostaglandins - Prostaglandins cause myometrial contraction and vasoconstriction of spiral arteries - vasoconstriction of spiral arteries causes ischaemic necrosis of the endometrium
139
What is primary dysmenorrhoea due to
Excess secretion of PGF2a and PGE from endometrial cells
140
How is dysmenorrhoea investigated
Examination STI Screen (Exclude PID) TV-US (Exclude fibrosis, adenomyosis, polyps)
141
What are 3 conservative measures to manage dysmenorrhoea
1. Smoking cessation 2. Hot water bottle 3. TENS
142
What is first-line pharmacological method for primary dysmenorrhoea
1. Analgesia (NSAIDs)
143
Why are NSAIDs preferred to paracetamol for dysmenorrhoea
NSAIDs inhibit prostaglandin production - part of pathology
144
What is second-line for dysmenorrhoea
COCP
145
What is intermenstrual bleeding also known as
Metotorrhagia
146
What is intermenstrual bleeding
Bleeding between menses
147
What % of AUB is due to intermenstrual bleeding
25
148
What is the main differential for intermenstrual bleeding
Cervical cancer
149
What is a more common cause of intermenstrual bleeding in young women
Cervical ectropion
150
What are other causes of intermenstrual bleeding
``` Cervical cancer Cervical polyps Infection Cervical ectropion Hormonal contraceptives (POP, Injection) Atrophic vaginitis Pregnancy ```
151
What infections may cause intermenstrual bleeding
Chlamydia | PID
152
What is intermenstrual bleeding
bleeding between menses
153
What should be ordered initially for intermenstrual bleeding
- Pregnancy Test - STI screen - Cervical smear test
154
If no cause identified in blood tests, what should be done to investigate intermenstrual bleeding
Colopscopy | TVUS
155
when should an individual be referred to gynaecology under 2W rule
If risk factors for cervical cancer and IM bleeding
156
what are 4 risk factors for cervical cancer
1. FH 2. Tamoxifen 3. Heavy IM bleeding 4. >45-years
157
how is intermenstrual bleeding managed
Treat underlying cause
158
what is post-coital bleeding
bleeding after sexual intercourse
159
what are 5 causes of post-coital bleeding
1. Infection 2. Cervicitis 3. Cervical cancer 4. Vaginal cancer 5. Cervical ectropion 6. Cervical polyps
160
what are two infectious causes of post-coital bleeding
Chlamydia | Gonorrhoea
161
what is cervical ectropion
Tissue from the endocervix is in the region of the ectocervix
162
what is cervicitis
Inflammation of the cervix
163
what may cause cervicitis
Chalmydia (most-common) | BV
164
when may vaginal cancer cause post-coital bleeding
In older patients
165
how will cervical cancer appear on examination
Contact bleeding
166
what presentation often occurs with post-coital bleeding
Inter-menstrual bleeding
167
what are 3 investigations for post-coital bleeding
1. STI 2. Cervical smear 3. Colposcopy
168
when should colposcopy be performed
If persistent post-coital bleeding with no previously identified cause

Gynaecology (22 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions