Abnormal Uterine Bleeding

Question 0

Differentials for primary amenorrhea?

Answer 0

With secondary sexual development

• hyperthyroidism
• hyperprolactinaemia
• PCOS
• hypothalamic dysfunction
• anatomical abnormalities e.g. Mullerian agenesis, imperforate hymen

Without secondary development

• high fsh
  
  • turners XO
• low fsh
  
  • constitutional delay (MC)
  • congenital (pituitary failure, GnRH deficiency)
• Acquired (DM1, pituitary tumours, systemic disposers IBD)

Question 1

What are the causes of abnormal uterine bleeding?

Answer 1

Menstrual

• structural: endometriosis/adenomyosis, fibroids
• NEOPLASTIC: endometrial cancer
• systemic: thyroid, bleeding diatheses

Intermenstrual

• structural : polyps, ectropion
• neoplasm: endometrial hyperplasia/cancer, cervical, vulval
• infection/ inflammation: endometritis, cervicitis

Question 2

Approach to pt with amenorrhea?

Answer 2

Bhcg
Prolactin
Progestin withdraw test (if no bleed -> ashermans syndrome/HP axis dysfunction)
FSH/LH