Abnormal vaginal bleeding Flashcards
Causes of meorrhagia
Polyp Adenomyosis Leiyomyoma Malignancy Coagulopathy Ovary dysfunction Iatrogenic - IUD Endometrial - hyperplasia, endometriosis Endocrine - hypothyroidism Not classified - DUB
Classification of abnormal vaginal bleeding
Post menopausal Intermenstrual Post coital Menorrhagia Dysmenorrhea Oligomenorrhoea >35 days apart Polymenorrhoea <21 days apart Pregnancy related (ectopic, missed/incomplete/threatened miscarriage, gestational trophoblastic disease)
Management of menorrhagia
Conservative: regular paracetamol, hot water bottle Drugs: mefenamic acid, tranexamic acid Regulating menstrual cycle: 1st line - IUS 2nd line - tranexamic acid, COCP
MoA of mefanamic acid
NSAID: COX inhibitor so reduces prostaglandin synthesis which reduced bleeding
MoA of tranexamic acid
Prevents breakdown of fibrin
Symptoms of cervical polyps
Menorrhagia
Post coital bleeding
Intermenstrual bleeding
Symptoms and signs of endometriosis
Dysmenorrhea I.e cyclical pelvic pain Dyspareunia Menorrhagia and/or polymenorrhoea Infertility Pain on defecation Fixed retroverted uterus (adhesions)
Common causes of post coital bleeding
Chlamydia infection
Cervical ectropion
Investigation for abnormal vaginal bleeding
Depends on symptoms and age: Hb, Fe, ferritin TFTs Clotting Pregnancy test TVUS (?pregnancy or ?endometrial Ca) Speculum and pelvic examination Cervical smear Hysteroscopy Laparoscopy
Laparoscopic findings in endometriosis
Powder burn spots
Endometrioma (blood filled ovarian cyst)
Fixed retroverted uterus
Diagnosis of PCOS
2/3 of following criteria:
Oligomenorrhoea or anovulation
Excess androgen (clinical or blood test)
At least 12 follicles on ovaries on TVUS
Blood tests suggesting PCOS
High testosterone
Low SHBG (due to high circulating insulin)
High LH:FSH
Symptoms and signs of PCOS
Anovulation Oligomenorrhoea Unintentional weight gain Hirsutism Acanthosis nigricans Enlarged ovaries on pelvic examination
Pathophysiology of PCOS
Chronic high LH due to high GnRH causes increased androgens
Androgens converted peripherally to oestrogen
Oestrogen maintains high LH by +ve feedback and suppresses FSH
Low FSH means follicles don’t mature so from cysts
Long term risks of PCOS
Endometrial cancer risk as unopposed oestrogen from anovulation (no corpus luteum to produce progesterone)
Type 2 diabetes
Recurrent miscarriage
Management of PCOS
Weight loss, may need metformin
COCP to regulate menstrual cycle
Cyproterone acetate to decrease androgens
Spironolactone or laser hair removal/electrolysis for hirsutism
Clomiphene citrate if trying to conceive
Primary vs secondary dysmenorrhea and causes
Primary - within 6 months of menarche. Caused by increased prostaglandin production.
Secondary - several years after menarche. Causes include endometriosis, adenomyosis, fibroids, adhesions.
Treatment of dysmenorrhea
Analgesia Hot water bottles Mefanamic acid IUS/COCP/POP Hysterectomy if don't want anymore children
Risk factors for fibroids
FH Early menarche Afro Caribbean Obesity Vit D deficiency
Classification of fibroids
Based on site:
Intramural
Subserosal
Submucosal
Symptoms and signs of fibroids
Menorrhagia Dysmenorrhea IM bleeding Urinary frequency Constipation Infertility Abdo pain Irregular enlarged uterus
Management options for fibroids
Analgesia e.g mefanamic acid Tranexamic acid IUS COCP Surgical if want to be made infertile - ablation, total hysterectomy, myomectomy
Management of PMS
Symptoms diary
Reduce alcohol, caffeine and quit smoking
Vitamin B6, D and Ca supplements
COCP
