abnormal vaginal bleeding Flashcards
at what age is abnormal vaginal bleeding higher risk of being serious?
45
woman >45y presents with heavy periods - what to do?
urgent referral for hysteroscopy + endometrial biopsy
endometrial polyps - diagnosis
hysteroscopy
2ww for abnormal/heavy vaginal bleeding - what are the red flags for referral? what investigations are done?
> 45y
no response to medical treatment
postmenopausal bleeding
post-coital bleeding
persistent intermenstrual bleeding
abnormalities O/E eg:
lesion on cervix
enlarged uterus
pelvic mass
fibroids - features
menorrhagia heaviness + pain in pelvis - esp on period urinary symptoms enlarged uterus oe bloating subfertility
3 non-gynae causes of AMB
bleeding disorder
anticoagulants
thyroid symptoms
AMB - significance of irregular bleeding?
irregular bleeding - concern re pathology
cervical pathology can cause irregular bleeding but not menorrhagia
causes of AMB - PALM COEIN? 2 extras in reproductive age?
Polyps
Adenomyosis
Leiomyoma (fibroid)
Malignancy
Coagulopathy Ovarian dysfunction - PCOS, declining ovarian function... Endometrial - menorrhagia... Iatrogenic Not yet classified - pregnancy, STI
2 causes of adolescent AMB
ovulatory dysfunction eg PCOS
coagulopathy eg VWD
AMB - likely cause when irregular/unpredictable?
ovulatory dysfunction - PCOS, perimenopausal anovulation
AMB - likely cause when intermenstrual?
anatomical cause - submucosal fibroid or uterine polyp
AMB - likely cause when chronic menorrhagia?
coagulopathy - VWD
signs of bleeding disorder on examination
petechiae + ecchymosis
pallor
swollen joints
AMB - investigations
pregnancy test FBC - anaemia TFTs - thyroid disease pelvic USS hysteroscopy + endometrial biopsy if necessary
AMB - management of anatomic source of bleeding eg fibroid, polyp
surgery
hysterectomy
IUS - how does it work to manage AMB?
progesterone reduces endometrial proliferation, reducing menstrual blood loss
SEs of IUS
ovarian cysts
acne + mood changes
breast soreness
IUS - risks
can come out
can embed into myometrium
IUS - follow up
speculum in 6wk to ensure in place
risks of endometrial ablation
infection
perforation
v bad for fertility + bad pregnancy outcomes
post-ablation syndrome - blood still released in uterine cavity but can’t escape - cyclic type pains ± heavy bleeding
AMB - management
mirena GnRH analogues resect polyp/fibroid endometrial ablation hysterectomy
how long after menarche do regular periods begin?
2-3y
which investigations are done if you 2ww someone for AMB?
hysteroscopy + endometrial biopsy
submucous fibroids - diagnosis
hysteroscopy
