Abnormal Uterine Bleeding

Question 1

What are the common causes of abnormal uterine bleeding?

Answer 1

• Coagulopathy
• Ovulatory Dysfunction
• Endometrial
• Iatrogenic
• Polyps
• Adenomyosis/Leiomyomas
• Malignancies
• Not yet specified

Question 2

What are the features of MENORRHAGIA?

Answer 2

Normally due to Fibroids or polyps. Can also be due to chronic pelvic infection, ovarian tumours, endometrial + cervical malignancies, thyroid disease or Van Willebrand disease

Investigate via blood tests (FBC, TFTs), Transvaginal ultrasound, Endometrial biopsy

Managed via fibroid surgery:

• Uterine artery embolisation
• Surgical removal
• Hysterectomy
• Myomectomy

Question 3

What are the features of INTERMENSTRUAL BLEEDING?

Answer 3

Anovulatory bleeds and are normally due to pelvic pathologies.

Similar investigations to Menorrhagia, as well as cervical smear (risk of CA)

Managed via medications if no anatomical cause is found (IUD/ Combined oral contraceptive pill, Transexamic acid/NSAIDs)

Question 4

What are the features of POST-COITAL BLEEDING?

Answer 4

Due to mild trauma, cervical ectropion, benign polyps, cervicitis/vaginitis, atrophic vaginitis or cervical CA

Managed via polyp ablation or cryotherapy for ectropion

Question 5

What are the features of DYSMENORRHOEA?

Answer 5

Either primary (no organic cause found) or secondary (pelvic pathology)

Managed via NSAIDs or ovulation suppression (OCP). If due to a secondary cause then treat secondary cause (e.g. polyps, endometriosis, PID etc.0

Question 6

What are the features of POST-MENOPAUSAL BLEEDING?

Answer 6

Normally caused by premalignancy or endometrial/cervical carcinoma. Can also be caused by atrophic vaginitis or withdrawal bleeding from HRT

Investigated via bimanual/speculum examination, cervical smear or a transverse vaginal ultrasound

Managed dependant on cause (structural/topical oestrogen)