Abnormal Menstrual Bleeding Flashcards
What are the common causes of heavy menstrual bleeding?
Idiopathic (40-60%)
Fibroids (30%)
Polyps (10%)
Other: clotting disorders, thyroid disease
What is the management of HMB?
1) Check Hb, treat as appropriate
2) Check clotting and TFTs
3) Transvaginal USS to exclude structural pathology
4) IUS (unless trying to conceive, then tranexamic acid and mefanamic acid)
What are the common causes of dysmenorrhoea?
Primary (idiopathic)
Secondary: fibroids, adenomyosis, endometriosis, PID, ovarian tumours
What is the management of primary dysmenorrhoea?
Hormonal contraception (COCP, IUS, progesterone implant)
What are the features of PCOS?
PCO on USS, irregular menstruation, hirsutism, acne, raised testosterone.
What result is found on FSH/LH bloods for PCOS?
Reversed FSH/LH ratio (high LH, normal FSH)
What other hormones should be measured in PCOS?
AMH (raised in PCOS)
Prolactin (exclude prolactinoma)
TSH (exclude thyroid disorders)
Testosterone (raised in PCOS)
What is management of PCOS?
Metabolic: diet and lifestyle. Metformin
Not trying to conceive: COCP
Trying to conceive: clomifene (anti-oestrogen, triggers FSH and LH release). Does carry risk of multiple pregnancies and low live birth rate.
What are the common causes of irregular menstrual bleeding?
Anovulatory cycles are common in early and late reproductive years.
Pelvic pathology: fibroids, uterine and cervical polyps, adenomyosis, ovarian cysts and chronic pelvic infection.
How should irregular menstrual bleeding be investigated?
Need to exclude malignancy: cervical smear, TV USS +/- biopsy.
What is management of irregular menstrual bleeding, once significant pelvic pathology excluded?
Hormonal contraceptives (COCP, IUS)
What are the causes of absent / infrequent menstrual bleeding?
Hypothalamus: low weight, stress, XS exercise
Pituitary: hyperprolactinaemia, hypopituitarism
Thyroid disease
Ovary: PCOS (high AMH), premature ovarian failure (low AMH), Turner’s
Outflow: imperforate hymen, cervical stenosis, Asherman’s syndrome
What are the causes of post-coital bleeding?
Cervical carcinoma, ectropion, cervical polyp, cervicitis, vaginitis
What are the features of fibroids?
50% aysmptomatic
HMB, IMB, dysmenorrhoea, urinary retention(pressing on bladder)
What is management of fibroids?
Only required if symptomatic. May try tranexamic acid, mefanamic acid, IUS.
GnRH highly effective, induce menopausal state. Limited to 6m unless add-back oestrogen used.
Surgery: myomectomy, hysterectomy, embolisation
