Abnormal uterine bleeding

Question 1

Menorrhagia

Answer 1

Prolonged period and increased blood flow

Question 2

Metorrhagia

Answer 2

Regular intermenstrual bleeding

Question 3

What is the term for periods occurring at less than 21 day interval?

Answer 3

Polymenorrhoea

Question 4

Amenorrhoea

Answer 4

Absence of period for over 6 consecutive months

Question 5

What is the term for periods occurring at intervals over 35 days?

Answer 5

Oligomenorrhoea

Question 6

It is abnormal to pass clots. True or false?

Answer 6

True

Question 7

What is post coital bleeding?

Answer 7

Bleeding after sex

Question 8

Causes of abnormal uterine bleeding in adolescence / early reproductive life

Answer 8

Dysfunctional UB
Pregnancy/miscarriage
Endometritis

Question 9

Causes of abnormal uterine bleeding in reproductive life

Answer 9

Pregnancy/miscarriage 
Dysfunctional UB 
Endometritis 
Polyps
Leiomyoma 
Adenomyosis 
Neoplasia

Question 10

Causes of abnormal uterine bleeding in post menopausal women

Answer 10

Atrophy
Endometrial polyp
Endometritis
Exogenous hormones

Question 11

Organic causes of menorrhagia?

Answer 11

Presence of pathology, there is something to see causing the abnormal bleeding

• local disorders: fibroids, polyps, leiomyoma etc
• systemic disorders: endocrine disorders, renal disease, liver disorders
• pregnancy related bleeding

Question 12

Non-organic causes of menorrhagia?

Answer 12

Absence of pathology aka dysfunctional uterine bleeding

Question 13

Dysfunctional uterine bleeding (DUB) - definition

Answer 13

Abnormal uterine bleeding with no organic cause
Must be a hormonal abnormality as it reflects a disruption in the normal pattern of ovulatory hormonal simulation to the endometrial lining

Question 14

DUB - what are the 2 types

Answer 14

Anovulatory

Ovulatory

Question 15

Which is most common: ovulatory or anovulatory DUB?

Answer 15

Anovulatory

Question 16

Anovulatory DUB - what happens

Answer 16

Occurs at extremes of reproductive life
Corpus luteum doesn’t form
- therefore there is insufficient progesterone and abnormal follicular development

Question 17

Anovulatory DUB - menstrual cycle

Answer 17

Irregular cycle

• some months you don’t have periods
• if you don’t ovulate, the endometrium continues to grow until it out-grows itself causing huge blood loss

Question 18

Ovulatory DUB - what is the cause?

Answer 18

Occurs in women 35-45

Due to inadequate progesterone production by the corpus luteum

Question 19

Ovulatory DUB - menstrual cycle

Answer 19

Regular heavy periods

Question 20

DUB investigations

Answer 20

FBC 
Cervical smear 
TSH - to exclude hypothyroidism
Coagulation screen 
Transvaginal US 
- check for fibroids or other pelvic masses 
Endometrial sampling

Question 21

DUB - medical management

Answer 21

Progestogens

• synthetic progesterone
• start taking at day 5 of cycle

Combined OCP
- ideal for younger patients

Anti-fibrinolytics
- tranexamic acid

Question 22

DUB - surgical management

Answer 22

Endometrial resection/ablation

Hysterectomy

Question 23

Endometritis - diagnosis

Answer 23

Recognised by an abnormal pattern of inflammatory cells

Question 24

When do endometrial polyps tend to occur?

Answer 24

Around/after menopause

Question 25

Endometrial polyps are always benign. True or false?

Answer 25

Mainly beingn | - be aware that endometrial cancer can present as a polyp

Question 26

Endometrial polyps - clinical features

Answer 26

Usually asymptomatic | May present with bleeding or discharge

Question 27

Adenomyosis - definition

Answer 27

Endometrial glands and storm within the myometrium

Question 28

Adenomyosis - clinical features

Answer 28

Menorrhagia | Dysmenorhea

Question 29

Leiomyoma - definition

Answer 29

Benign tumour of smooth muscle

Question 30

Leiomyoma - clinical features

Answer 30

Menorrhagia Infertility Mass effect Pain