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4: Y4 - Gynaecology [8] > [35] Intermenstrual, Breakthrough, and Post-coital Bleeding > Flashcards

[35] Intermenstrual, Breakthrough, and Post-coital Bleeding Flashcards

1
Q

What is intermenstrual bleeding (IMB)?

A

Vaginal bleeding at any time during the menstrual cycle other than during normal menstruation

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2
Q

What can IMB be difficult to distinguish from sometimes?

A

Metrorrhagia

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3
Q

What is metrorrhagia?

A

Irregularly frequent periods

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4
Q

What is post-coital bleeding (PCB)?

A

Non-menstrual bleeding that occurs immediately after sexual intercourse

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5
Q

What is breakthrough bleeding?

A

Irregular bleeding associated with hormonal contraception

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6
Q

What are IMB and PCB classified as?

A

Symptoms

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7
Q

What is the result of IMB and PCB being symptoms?

A

They require further investigation

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8
Q

What is the biggest differentiator of causes of abnormal bleeding?

A

Age

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9
Q

What is an uncommon cause of PV bleeding in young women?

A

Malignancy

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10
Q

What happens to the likelihood of uterine polyps and fibroids with age?

A

Increases

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11
Q

What are the possible causes of PCB?

A
  • Infection
  • Cervical ectropion
  • Cervical or endometrial polyps
  • Vaginal cancer
  • Cervical cancer
  • Trauma or sexual abuse
  • Vaginal atrophic change
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12
Q

What % of women with PCB have no specific cause found?

A

50%

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13
Q

What are the possible causes of intermenstrual bleeding?

A
  • Pregnancy related
  • Physiological
  • Vaginal causes
  • Cervical causes
  • Uterine causes
  • Iatrogenic causes
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14
Q

What pregnancy related causes can lead to IMB?

A
  • Ectopic pregnancy

- Gestational trophoblastic disease

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15
Q

What can be a physiological cause of IMB?

A

Spotting during ovulation

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16
Q

What % of women have spotting during ovulation?

A

1-2%

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17
Q

What are the vaginal causes of IMB?

A
  • Adenosis
  • Vaginitis
  • Tumours
18
Q

What are the cervical causes of IMB?

A
  • Infection
  • Cancer
  • Cervical polyps
  • Cervical ectropion
19
Q

What infections of the cervix can cause IMB?

A
  • Chlamydia

- Gonorrhoea

20
Q

What are the uterine causes of IMB?

A
  • Fibroids
  • Endometrial polyps
  • Cancer
  • Adenomyosis
  • Endometriosis
21
Q

What are the iatrogenic causes of IMB?

A
  • Tamoxifen
  • Following smear or cervix treatment
  • Missed OCP
  • Drugs altering clotting
22
Q

What drugs that alter clotting can cause IMB?

A
  • Anti-coagulants
  • SSRIs
  • Corticoteroids
23
Q

When is breakthrough bleeding most common?

A

When a new contraceptive is started, and often settles without intervention

24
Q

What type of hormonal contraceptives are more likely to cause bleeding problems?

A

Progesterone only

25
Q

What should be asked about when taking a history for abnormal pre-menopausal vaginal bleeding?

A
  • Menstrual history
  • Obstetric history
  • Gynaecological history
  • Sexual history
  • Medical history
  • Current medication
26
Q

What should be examined when assess abnormal pre-menopausal vaginal bleeding?

A
  • BMI
  • Abdomen
  • Speculum
  • Bimanual
27
Q

What can be looked for on abdominal examination when a patient presents with abnormal pre-menopausal vaginal bleeding?

A

Presence of any pelvic masses

28
Q

What should be looked for on vaginal examination in a woman with abnormal pre-menopausal vaginal bleeding?

A

Any obvious genital tract pathology

29
Q

What are some common findings on vaginal examination in abnormal pre-menopausal vaginal bleeding?

A
  • Cervical ectropion
  • Cervical polyp
  • Cervicitis
30
Q

What investigations can be made into women with abnormal pre-menopausal vaginal bleeding?

A
  • Pregnancy test
  • Infection screen
  • Blood tests
  • Transvaginal USS
  • Endometrial bopisy
31
Q

What blood tests can help identify a cause of abnormal pre-menopausal vaginal bleeding?

A
  • FBC
  • Clotting
  • TFTs
  • FSH/LH
32
Q

What can a transvaginal USS look for in a woman with abnormal vaginal bleeding?

A

Structural abnormalities

33
Q

What does management of abnormal pre-menopausal vaginal bleeding depend on?

A

The type and cause of the bleeding

34
Q

What is the first management step if cancer is the suspected cause of abnormal pre-menopausal vaginal bleeding?

A

Urgent referral for further investigation

35
Q

What are the management steps if infection is the suspected cause of abnormal pre-menopausal vaginal bleeding?

A

Antibiotics (if appropriate) and contact tracing

36
Q

What is the management if hormonal contraception is considered to be the cause of abnormal pre-menopausal vaginal bleeding?

A

Advise that it is normal in the first 3 months but can swap if persistent

37
Q

How can cervical ectropion be treated?

A
  • Conservatively

- Cauterisation

38
Q

How is cervical ectropion cauterised?

A

With silver nitrate

39
Q

How should cervical polyps be managed?

A

Evulsed and sent for histology

40
Q

How can fibroids be managed?

A
  • Hysteroscopic removal for small fibroids
  • Uterine artery embolisation
  • Medical management with oestrogen reducing drugs

4: Y4 - Gynaecology [8] (52 decks)

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