2 - Gynae - Menstrual Cycle and its disorders - Irregular Menstrual and Intermenstrual bleeding

Question 1

more common when? why? may coexist w? non-mal causes include?

Answer 1

extremes of reproductive age - due to anovulatory cycles being more common
w/ HMB

fibroids, ovarian cysts, uterine/cervical polyps, adenomyosis, chronic pelvic infection

Question 2

Woman should be assessed for? what examination may reveal…..? what Ix is always done?

Answer 2

menorrhagia
speculum may reveal cervical polyp
Hb to check effect of BL and fitness

Question 3

What is taken if required? what must be excluded? USS for who? can also detect what?

Answer 3

smear
malignancy
>35s w irreg/IM bleeding, and in younger if med trt failed - also detects ovarian mass/fibroids

Question 4

when is endometrial biopsy used? with what during what?

Answer 4

with pipelle during hysteroscopy

if endometrium thickened, polyp suspected, woman is >40, or if ablative surgery/IUS to be used

Question 5

MGMT - when drugs appropriate? what are 1st line? effect? limitations?

Answer 5

where no anatomical causes detected - cycles considered anovulatory

IUS or COCP - COCP usually gives regular and lighter menstruation - role of COCP limited as complx more common in older pts

Question 6

MGMT - what other medical trts are there? how might they help? limitations?

Answer 6

progestogens
-amenorrhoea BUT bleeding follows after withdrawal - mimic normal menstruation when given cyclically
OR
HRT
-may regulate erratic uterine bleeding during menopause

Question 7

what surgical mgmt can be used? what techniques less helpful?

Answer 7

cervical polyp can be avulsed and sent for histo Ex

surgery same as HMB mgmt - but ablative techniques less helpful as endometrium remains and so irreg but light bleeding may occur