Abnormal Vaginal Bleeding

Question 1

Structural causes

Answer 1

Polyps
Adenomyosis
Leiomyoma
Malignancy

Question 2

Non-structural

Answer 2

Coagulopathy
Ovulatory Dysfunction
Endometrial
Iatrogenic
Not Classified

Question 3

Regular

Answer 3

Adenomyosis
Leiomyoma
Coagulopathy
Endometrial
Iatrogenic

Question 4

Irregular

Answer 4

Polyps
Ovulatory Dysfunction
Malignancy
Iatrogenic

Question 5

Pathogenesis of Adenomyosis

Answer 5

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.

Question 6

Discuss the symptoms of Adenomyosis.

Answer 6

Dysmenorrhoea: Distension of endometrial tissue in the myometrium as the cycle progresses.

Heavy Bleeding: Additional endometrial tissue in the myometrium.

Chronic Pelvic Pain

Question 7

Findings on bimanual examination for Adenomyosis.

Answer 7

Tender, bulky uterus

Question 8

U/S for Adenomyosis

Answer 8

moderately enlarged, globular uterus with cystic areas (endometrial deposits)

Question 9

Management of Adenomyosis

Answer 9

Complete family:
-Hysterectomy
- Uterine artery embolization

Desire fertility:
-Potent Analgesia
- COC/ Prog Injectable/ Mirena

Question 10

Pathogenesis of coagulopathy issues.

Answer 10

After being torn, blood vessels unable to clot.
Usually inherited.
other bleeding issues.

Question 11

How do you manage coagulopathy issues.

Answer 11

Underlying cause
Hormonal contraceptives to thin endometrium.
Pro-coagulants (tranexamic acid and NSAIDS) only on period.

Question 12

Discuss Primary disorder of endometrial haemostasis.

Answer 12

Diagnosis of exclusion
Normal ovulation and regular cycles
Poor local haemostasis: prostaglandin pathway is dysfunctional.

Question 13

Management of Primary disorder of endometrial haemostasis.

Answer 13

NSAIDs to correct prostaglandin pathway.
Tranexamic acid, decrease blood loss.

Question 14

Describe the Vaginal examination of Polyps.

Answer 14

Normal.

Question 14

Discuss Polyps

Answer 14

Hyperplastic overgrowths of endometrial glands and stroma
More likely to be malignant if bleeding or postmenopausal women.

Question 15

investigation of polyps in premenopausal women.

Answer 15

US

Question 16

Investigations of polyps in a postmenopausal woman.

Answer 16

Gold Standard Hysteroscopy,
Pipelle for blind sampling.

Question 17

Discuss Ovulatory Dysfunction.

Answer 17

Due to an imbalance between Progesterone and Oestrogen.
A problem along the axis, thyroid and thalamus.
Also adipose tissue.

Question 18

What is anovulatory bleeding?

Answer 18

Insufficient LH surge.
no ovulation
no menstruation.
Endometrial lining continues to grow and no shed.
sporadic ovulation and heavy bleeding in a few months.

Question 19

Pathogenesis of PCOS.

Answer 19

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.

Question 20

Short term complaints of PCOS.

Answer 20

Oligomennorhea
Infertility
Hirsutism.

Question 21

Long term concerns of PCOS

Answer 21

Obesity, insulin resistance and diabetes
Hypercholesterolemia
Hypertension
Endometrial Ca.

Question 22

Rotterdam consensus or Diagnosis of PCOS.

Answer 22

Oligo/ Anovulatory
Virilising (blood chemistry: Testoerone)
Polycystic ovaries on US
>_ 2

Question 23

Management of PCOS.

Answer 23

Directed at Primary presenting complaint.
Cycle: COC
Weight loss
Infertility: refer
Hirsutism: Diane (not in state)

Question 24

Which Iatrogenic (medication) cause irregular bleeding?

Answer 24

Hormonal

Question 25

Which Iatrogenic (medication) cause regular bleeding?

Answer 25

Cu IUCD
Anticoagulants