Abnormal Vaginal Bleeding Flashcards
Structural causes
Polyps
Adenomyosis
Leiomyoma
Malignancy
Non-structural
Coagulopathy
Ovulatory Dysfunction
Endometrial
Iatrogenic
Not Classified
Regular
Adenomyosis
Leiomyoma
Coagulopathy
Endometrial
Iatrogenic
Irregular
Polyps
Ovulatory Dysfunction
Malignancy
Iatrogenic
Pathogenesis of Adenomyosis
Usually Parous women
Detachmen of placenta disrupts the endo-myometrial junctions
As a result the endometrial glands and the stroma grows into the myometrium (hypertrophy)
This causes the menses to burrow.
Discuss the symptoms of Adenomyosis.
Dysmenorrhoea: Distension of endometrial tissue in the myometrium as the cycle progresses.
Heavy Bleeding: Additional endometrial tissue in the myometrium.
Chronic Pelvic Pain
Findings on bimanual examination for Adenomyosis.
Tender, bulky uterus
U/S for Adenomyosis
moderately enlarged, globular uterus with cystic areas (endometrial deposits)
Management of Adenomyosis
Complete family:
-Hysterectomy
- Uterine artery embolization
Desire fertility:
-Potent Analgesia
- COC/ Prog Injectable/ Mirena
Pathogenesis of coagulopathy issues.
After being torn, blood vessels unable to clot.
Usually inherited.
other bleeding issues.
How do you manage coagulopathy issues.
Underlying cause
Hormonal contraceptives to thin endometrium.
Pro-coagulants (tranexamic acid and NSAIDS) only on period.
Discuss Primary disorder of endometrial haemostasis.
Diagnosis of exclusion
Normal ovulation and regular cycles
Poor local haemostasis: prostaglandin pathway is dysfunctional.
Management of Primary disorder of endometrial haemostasis.
NSAIDs to correct prostaglandin pathway.
Tranexamic acid, decrease blood loss.
Describe the Vaginal examination of Polyps.
Normal.
Discuss Polyps
Hyperplastic overgrowths of endometrial glands and stroma
More likely to be malignant if bleeding or postmenopausal women.
investigation of polyps in premenopausal women.
US
Investigations of polyps in a postmenopausal woman.
Gold Standard Hysteroscopy,
Pipelle for blind sampling.
Discuss Ovulatory Dysfunction.
Due to an imbalance between Progesterone and Oestrogen.
A problem along the axis, thyroid and thalamus.
Also adipose tissue.
What is anovulatory bleeding?
Insufficient LH surge.
no ovulation
no menstruation.
Endometrial lining continues to grow and no shed.
sporadic ovulation and heavy bleeding in a few months.
Pathogenesis of PCOS.
High testosterone levels and oestrogen and progesterone ratios are reversed.
Virilization and menstrual irregularities.
No LH surge, no ovulation.
Follicles are primed and backed up in the ovaries, known as cysts.
Short term complaints of PCOS.
Oligomennorhea
Infertility
Hirsutism.
Long term concerns of PCOS
Obesity, insulin resistance and diabetes
Hypercholesterolemia
Hypertension
Endometrial Ca.
Rotterdam consensus or Diagnosis of PCOS.
Oligo/ Anovulatory
Virilising (blood chemistry: Testoerone)
Polycystic ovaries on US
>_ 2
Management of PCOS.
Directed at Primary presenting complaint.
Cycle: COC
Weight loss
Infertility: refer
Hirsutism: Diane (not in state)
Which Iatrogenic (medication) cause irregular bleeding?
Hormonal
Which Iatrogenic (medication) cause regular bleeding?
Cu IUCD
Anticoagulants
