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Obs & Gynae (Gynae) > Abnormal Vaginal Bleeding > Flashcards

Abnormal Vaginal Bleeding Flashcards

1
Q

What are the physiological causes of amenorrhoea?

A

Pregnancy, lactation, menopause

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2
Q

Which gynaecological malignancies may present with abnormal vaginal bleeding?

A

Endometrial, cervical, vaginal and vulval

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3
Q

Primary amenorrhoea is defined as the absence of menstruation by what age?

A

16 years

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4
Q

In secondary amenorrhoea, there is absence of menstruation for how long, that is not explained by a physiological cause?

A

6 months or more

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5
Q

What are some medications that may cause amenorrhoea?

A

Hormonal contraceptives and dopamine antagonists (anti-emetics, anti-psychotics)

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6
Q

What is Asherman’s syndrome?

A

Intra-uterine adhesions

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7
Q

What is the most common cause for amenorrhoea associated with cyclic pain?

A

Imperforate hymen

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8
Q

What is the most important investigation to perform on any woman presenting with amenorrhoea?

A

Pregnancy test

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9
Q

What imaging investigation is used in women with amenorrhoea to confirm the presence or absence of normal pelvic anatomy, and to identify the site of any possible obstruction?

A

Transvaginal US

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10
Q

With what investigation can intra-uterine adhesions be diagnosed and treated?

A

Hysteroscopy

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11
Q

What imaging investigation is indicated if a hypothalamic-pituitary cause is suspected in a woman with amenorrhoea?

A

Pituitary MRI

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12
Q

What investigation is used to identify underlying chromosomal abnormalities which may be a cause of amenorrhoea?

A

Karyotyping

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13
Q

If a patient is amenorrhoeic, aged < 50 and does not wish to become pregnant, what treatment is indicated?

A

HRT

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14
Q

What two options are available as prevention of osteoporosis in amenorrhoeic women aged < 50?

A

HRT or COCP

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15
Q

Oligomenorrhoea is defined as menstruation with abnormally long intervals between periods. How long are these intervals?

A

> 35 days

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16
Q

Who is oligomenorrhoea most likely to occur in, and what is it associated with in these cases?

A

Adolescent girls and peri-menopausal women, associated with failed ovulation

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17
Q

In patients with anovulatory DUB, what treatment can be used to impose regular endometrial shedding or withdrawal bleeds?

A

COCP

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18
Q

Inflammatory disorders causing menorrhagia (e.g. endometriosis, adenomyosis) are most likely to be associated with which other symptom?

A

Dysmenorrhoea

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19
Q

What are some endocrine conditions which may cause menorrhagia?

A

PCOS, hypothyroidism

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20
Q

What are some medications that may be responsible for causing menorrhagia?

A

Cu-IUD, progesterone-only contraceptives, warfarin

21
Q

20-60% of women with menorrhagia will have what complication as a result?

A

Iron deficiency anaemia

22
Q

What are some examples of heavy menstrual bleeding which are always abnormal?

A

Changing protection hourly, flooding and passing clots

23
Q

If a pelvic examination is abnormal in someone with heavy menstrual bleeding, what is the first line imaging investigation?

A

Trans-vaginal US

24
Q

What investigation is recommended in all women aged > 45 with abnormal vaginal bleeding to exclude endometrial hyperplasia/cancer as the underlying cause?

A

Endometrial biopsy

25
Q

What is the first line imaging investigation for diagnosing fibroids?

A

Trans-vaginal US

26
Q

What is the first line treatment for menorrhagia with no identifiable, treatable underlying cause?

A

Mirena-IUS

27
Q

What is the second line treatment for menorrhagia with no identifiable, treatable underlying cause where the woman also wants contraception?

A

COCP

28
Q

What medication can be used to treat menorrhagia in women who do not want contraception or hormonal methods of management?

A

Tranexamic acid

29
Q

What medication can be given alongside tranexamic acid in women who suffer from menorrhagia and dysmenorrhoea?

A

Mefenamic acid

30
Q

When should tranexamic and mefenamic acid be started in terms of the menstrual cycle?

A

The first day of the period

31
Q

What are some surgical options for menorrhagia if medical management has failed?

A

Endometrial ablation/resection or hysterectomy

32
Q

What is the disadvantage to surgical management options for menorrhagia?

A

They remove fertility

33
Q

In what age group is dysmenorrhoea most common?

A

Adolescents and young women

34
Q

Primary dysmenorrhoea is thought to be associated with excessive production of what by the uterus?

A

Prostaglandins

35
Q

What is the most common cause of secondary dysmenorrhoea?

A

Endometriosis

36
Q

Uterosacral nodularity and/or tenderness, and a fixed, retroverted uterus on examination is most suggestive of what diagnosis?

A

Endometriosis

37
Q

What is adenomyosis?

A

Endometrial cells are found in the myometrium

38
Q

Deep dyspareunia, dysmenorrhoea and menorrhagia are most suggestive of what diagnosis?

A

Endometriosis

39
Q

What cause of dysmenorrhoea is associated with a history of STIs and chronic pelvic pain?

A

PID

40
Q

If an anatomical abnormality is suspected as the cause of dysmenorrhoea, what is the first line investigation?

A

Trans-vaginal US

41
Q

What is the gold standard investigation for suspected endometriosis?

A

Laparoscopy

42
Q

What are some medical management options for primary dysmenorrhoea?

A

NSAIDs and hormonal contraceptives

43
Q

If a woman presents with inter-menstrual or post-coital bleeding, what three investigations should always be done?

A

Pregnancy test, cervical cytology (if due), high vaginal and endocervical swabs

44
Q

If a woman presents with inter-menstrual or post-coital bleeding, and findings on examination are suspicious, what imaging investigations are indicated?

A

Trans-vaginal US and colposcopy

45
Q

What is the definition of post-menopausal bleeding?

A

PV bleeding > 12 months after the last menstrual period

46
Q

What are the two most common, benign causes of post-menopausal bleeding?

A

Atrophic vaginitis, unscheduled bleeding on HRT

47
Q

On trans-vaginal US, an endometrial thickness of what would make you suspicious of endometrial cancer? What further investigation would then be indicated?

A

5mm or more - endometrial biopsy would be the next best investigation

48
Q

How should post-menopausal bleeding as a result of vaginal atrophy be treated?

A

Oestrogen pessary or cream

49
Q

What is the most common cause of post-coital bleeding?

A

Cervical ectropion

Obs & Gynae (Gynae) (5 decks)

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