abnormal bleeding in pre and peri menopausal women

Question 1

risk factors for endometrial cancer

Answer 1

history of chronic anovulation
exposure to unopposed oestrogen
PCOS
exposure to tamoxifen
strong family history of endometrial or colon cancer
nulliparity
obesity

Question 2

labs

Answer 2

FBC
TFT if indicators of thyroid disorder
coags (von willebrand)

Question 3

TVUS

Answer 3

best performed in the first half of the menstrual cycle
endometrial thickness

Question 4

conservative treatment

Answer 4

: the use of hormone
therapy or non-hormonal pharmacological
therapy to reduce heavy bleeding, and control
irregular bleeding. More aggressive treatment
options include the surgical options of
endometrial ablation or hysterectomy.

Question 5

tamoxifen

Answer 5

endometrial biopsy should be used to assess women on tamoxifen experiencing vaginal bleeeding, as TVUS has been shown to be neither sensitive no specific for neoplasia in these women

Question 6

HRT

Answer 6

Vaginal bleeding or spotting may be
an expected side effect of HRT, thus
routine evaluations of the endometrium
are not essential in the first 6 months.
However, if bleeding persists after the
initial 6 months, evaluation should be
undertaken. Bleeding outside the time of
progestin withdrawal is deemed atypical
for women using cyclic progestins, and
requires investigation.

Question 7

hormonal IUDs

Answer 7

mirena and kyleena
both release levonorgestrel
lighter and less painful periods
can be removed at any time and fertility restores quickly

Question 8

copper IUD

Answer 8

not suitable for iron deficiency anaemia or those with heavy painful periods

Question 9

implanon

Answer 9

can cause light periods or no periods at all
may cause acne or mood changes

Question 10

types of emergency contraception

Answer 10

Question 11

contraindications for use of COCP

Answer 11

breastfeeding orr <6 weeks post partum
smoking
risk factors for CVD
hypertension
vasscular disease
major surgery
VTE
thrombogenic mutations
migraine with aura
IHD
vlvular heart disease
diabetes
brreast cancer
liver disease
raynauds
SLE

Question 12

contraceotive depot

Answer 12

progestogen given into the muscle every 12 weeks
may affect bone density
has to wear off

Question 13

why shouldnt you use depot for older women

Answer 13

due to bone density issues

Question 14

why should you be careful about COCP in older women

Answer 14

high cardiovascular risk - used pogestogen only instead

Question 15

for how long do women need contraception

Answer 15

until 12 months of amonorhhea if >50 or 24 months if <50
cant judge amonorrhea if on hormona contraception so use two FSH readings at least 6 weeks apart
assume post menopausal if >50