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Year 4 Core Conditions GOSH > Abnormal Vaginal Bleeding > Flashcards

Abnormal Vaginal Bleeding Flashcards

1
Q

5 things required for normal menstruation to occur

A
  1. hypothalamic function
  2. pit. function
  3. ovarian function
  4. endometrial function
  5. patent cervix and vagina
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2
Q

What is mehorrhagia?

A

heavy menstrual bleeding in cyclical patterns which interferes with physical and social and emotional QoL

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3
Q

Best way of diagnosing menorrhagia

A

pictorial blood loss assessment charts are the best way but many doctors will diagnose based on subjective assessment

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4
Q

Systemic causes of HMB

A

thyroid disease

clotting disorders

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5
Q

Local causes of HMB

A 
fibroids
endometrial polyps/carcinoma
endometriosis
PID
dysfunctional uterine bleeding
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6
Q

Iatrogenic causes of HMB

A

IUDs

Oral anticoagulants

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7
Q

Why do fibroids and polyps cause vaginal bleeding?

A
  1. they englarge the uterine cavity and so increase the SA of the endometrium
  2. they may secrete prostaglandins
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8
Q

Which local cause of HMB is diagnosed by exclusion?

A

Dysfunctional uterine bleeding

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9
Q

Which questions can help diagnose a proper HMB?

A

Flooding
Sanitary replacement
Clots
Nocturnal bleeding

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10
Q

What might be found on examination of a patient presenting with HMB?

A 
Signs of anaemia
Signs of thyroid disease
Abdominal mass may be present
Vaginal discharge
Polyps/fibroids
cervical motion tenderness
enlarged uterus
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11
Q

Which blood tests are relevant for a pt presenting with HMB?

A

FBC
Thyroid
Clotting

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12
Q

Which imagining techniques will assist the Dx of HMB?

A

TVUSS / abdominal ultrasound

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13
Q

When should an endometrial biopsy be routinely taken?

A

Women aged over 45 with HMB and under 45 if there are risk factors for endometrial cancer

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14
Q

Apart from a gynaecology and obstetric history, which other history is key in a woman presenting with HMB?

A

Sexual history

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15
Q

Which antifibrinoltyic drug can be prescribed to help in HMB?

A

transexamic acid

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16
Q

Which other drug can be prescribed to help in HMB?

A

NSAIDs mefenamic acid, indomethacin or aspirin

17
Q

What needs to be taken into account before providing a hormonal treatment for women?

A

fertility desires

18
Q

Which IUS system is commonly prescribed in women who do not wish to conceive?

A

Mirena coil (levonorgestrel)

19
Q

What is the risk of using GnRH agonists over a long period of time?

A

Bone density loss

20
Q

What else should be prescribed with a GnRH agonist if it is planned to be used over a long period?

A

Add back hormone therapy

21
Q

Which surgical procedures can be used to treat HMB?

A

Endometrial ablation

Hysterectomy

22
Q

Which three systems can the causes of IMB and PCB be split into?

A

Cervical
Intrauterine
Hormonal

23
Q

What are seam cervical causes of IMB/PCB?

A

Ectopy
Polyps
Malignancy
Cervicitis

24
Q

What are some intra-uterine causes of IMB/PCB?

A 
Polyps
Submucosal fibroids
Endometrial hyperplasia
Endometrial malignancy 
Endometritis
25
Q

Breakthrough bleeding is usually due to what cause?

A

Hormonal changes

26
Q

Which investigations should be considered in a woman with unexplained symptoms of IMB/PCB?

A 
HVS + ECS: rule out STI
Cervical smear: exclude CIN or cervical cancer
Pelvic USS: identify polyps or fibroids
Hysteroscopy: for biopsy
Laparoscopy: identify pelvic pathology
27
Q

What are some possible treatment options for IMB/PCB?

A

Abx for any infections
Cautery to cervical surface
Removal of polyps/fibs

28
Q

Why does PMB require prompt investigation?

A

Malignancy needs to be excluded

29
Q

What percentage of women presenting with PMB will have a malignancy?

A

9%

30
Q

Using anatomical regions of the female genital tract as a guide, what are some causes of PMB?

A

Ovaries: ovarian cancer, oes. sec. tumour

Uterus: Fibroid,polyp, hyperplasia, carcinoma

Cervix: atrophic changes, malignancy

Vagina: haematuria

Vulva: vulvitis, dystrophies, malignancies

31
Q

What is the most common cause of PMB?

A

Atrophic changes to the lower genital tract due to oestrogen deficiency

32
Q

Which physical change to the body can bring on PMB?

A

Gaining weight

33
Q

Which other symptoms may accompany atrophic changes to the genital tract?

A

Vaginal dryness, soreness, superficial dyspareunia

34
Q

What might you see O/E of a pt presenting with oestrogen deficiency as a cause of PMB?

A

Signs of anemia
Abdominal tenderness or masses
Vulval lesions

35
Q

Which investigations should be performed on all women with PMB?

A

Pelvic USS
Hysteroscopic examination of the uterus
Endometrial biopsy

36
Q

What is the most common medical treatment for PMB?

A

Oestrogen replacement either with progesterone as HRT or as a local cream/ring/pessary

Year 4 Core Conditions GOSH (3 decks)

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