abnormal vaginal bleeding

Question 1

at what age is abnormal vaginal bleeding higher risk of being serious?

Answer 1

45

Question 2

woman >45y presents with heavy periods - what to do?

Answer 2

urgent referral for hysteroscopy + endometrial biopsy

Question 3

endometrial polyps - diagnosis

Answer 3

hysteroscopy

Question 4

2ww for abnormal/heavy vaginal bleeding - what are the red flags for referral? what investigations are done?

Answer 4

> 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

Question 5

fibroids - features

Answer 5

menorrhagia
heaviness + pain in pelvis - esp on period
urinary symptoms
enlarged uterus oe
bloating
subfertility

Question 6

3 non-gynae causes of AMB

Answer 6

bleeding disorder
anticoagulants
thyroid symptoms

Question 7

AMB - significance of irregular bleeding?

Answer 7

irregular bleeding - concern re pathology

cervical pathology can cause irregular bleeding but not menorrhagia

Question 8

causes of AMB - PALM COEIN? 2 extras in reproductive age?

Answer 8

Polyps
Adenomyosis
Leiomyoma (fibroid)
Malignancy

Coagulopathy
Ovarian dysfunction - PCOS, declining ovarian function...
Endometrial - menorrhagia...
Iatrogenic
Not yet classified - pregnancy, STI

Question 9

2 causes of adolescent AMB

Answer 9

ovulatory dysfunction eg PCOS

coagulopathy eg VWD

Question 10

AMB - likely cause when irregular/unpredictable?

Answer 10

ovulatory dysfunction - PCOS, perimenopausal anovulation

Question 11

AMB - likely cause when intermenstrual?

Answer 11

anatomical cause - submucosal fibroid or uterine polyp

Question 12

AMB - likely cause when chronic menorrhagia?

Answer 12

coagulopathy - VWD

Question 13

signs of bleeding disorder on examination

Answer 13

petechiae + ecchymosis
pallor
swollen joints

Question 14

AMB - investigations

Answer 14

pregnancy test
FBC - anaemia
TFTs - thyroid disease
pelvic USS
hysteroscopy + endometrial biopsy if necessary

Question 15

AMB - management of anatomic source of bleeding eg fibroid, polyp

Answer 15

surgery

hysterectomy

Question 16

IUS - how does it work to manage AMB?

Answer 16

progesterone reduces endometrial proliferation, reducing menstrual blood loss

Question 17

SEs of IUS

Answer 17

ovarian cysts
acne + mood changes
breast soreness

Question 18

IUS - risks

Answer 18

can come out

can embed into myometrium

Question 19

IUS - follow up

Answer 19

speculum in 6wk to ensure in place

Question 20

risks of endometrial ablation

Answer 20

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

Question 21

AMB - management

Answer 21

mirena
GnRH analogues
resect polyp/fibroid
endometrial ablation
hysterectomy

Question 22

how long after menarche do regular periods begin?

Answer 22

2-3y

Question 23

which investigations are done if you 2ww someone for AMB?

Answer 23

hysteroscopy + endometrial biopsy

Question 24

submucous fibroids - diagnosis

Answer 24

hysteroscopy

Question 25

what is endometrial ablation?

Answer 25

outpatient procedure

removal of endometrial lining in women with menorrhagia

Question 26

female with postmenopausal bleeding - what is the concern?

Answer 26

endometrial cancer - until proven otherwise