Abnormal Vaginal Bleeding Flashcards
What are the physiological causes of amenorrhoea?
Pregnancy, lactation, menopause
Which gynaecological malignancies may present with abnormal vaginal bleeding?
Endometrial, cervical, vaginal and vulval
Primary amenorrhoea is defined as the absence of menstruation by what age?
16 years
In secondary amenorrhoea, there is absence of menstruation for how long, that is not explained by a physiological cause?
6 months or more
What are some medications that may cause amenorrhoea?
Hormonal contraceptives and dopamine antagonists (anti-emetics, anti-psychotics)
What is Asherman’s syndrome?
Intra-uterine adhesions
What is the most common cause for amenorrhoea associated with cyclic pain?
Imperforate hymen
What is the most important investigation to perform on any woman presenting with amenorrhoea?
Pregnancy test
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?
Transvaginal US
With what investigation can intra-uterine adhesions be diagnosed and treated?
Hysteroscopy
What imaging investigation is indicated if a hypothalamic-pituitary cause is suspected in a woman with amenorrhoea?
Pituitary MRI
What investigation is used to identify underlying chromosomal abnormalities which may be a cause of amenorrhoea?
Karyotyping
If a patient is amenorrhoeic, aged < 50 and does not wish to become pregnant, what treatment is indicated?
HRT
What two options are available as prevention of osteoporosis in amenorrhoeic women aged < 50?
HRT or COCP
Oligomenorrhoea is defined as menstruation with abnormally long intervals between periods. How long are these intervals?
> 35 days
Who is oligomenorrhoea most likely to occur in, and what is it associated with in these cases?
Adolescent girls and peri-menopausal women, associated with failed ovulation
In patients with anovulatory DUB, what treatment can be used to impose regular endometrial shedding or withdrawal bleeds?
COCP
Inflammatory disorders causing menorrhagia (e.g. endometriosis, adenomyosis) are most likely to be associated with which other symptom?
Dysmenorrhoea
What are some endocrine conditions which may cause menorrhagia?
PCOS, hypothyroidism
What are some medications that may be responsible for causing menorrhagia?
Cu-IUD, progesterone-only contraceptives, warfarin
20-60% of women with menorrhagia will have what complication as a result?
Iron deficiency anaemia
What are some examples of heavy menstrual bleeding which are always abnormal?
Changing protection hourly, flooding and passing clots
If a pelvic examination is abnormal in someone with heavy menstrual bleeding, what is the first line imaging investigation?
Trans-vaginal US
What investigation is recommended in all women aged > 45 with abnormal vaginal bleeding to exclude endometrial hyperplasia/cancer as the underlying cause?
Endometrial biopsy
What is the first line imaging investigation for diagnosing fibroids?
Trans-vaginal US
What is the first line treatment for menorrhagia with no identifiable, treatable underlying cause?
Mirena-IUS
What is the second line treatment for menorrhagia with no identifiable, treatable underlying cause where the woman also wants contraception?
COCP
What medication can be used to treat menorrhagia in women who do not want contraception or hormonal methods of management?
Tranexamic acid
What medication can be given alongside tranexamic acid in women who suffer from menorrhagia and dysmenorrhoea?
Mefenamic acid
When should tranexamic and mefenamic acid be started in terms of the menstrual cycle?
The first day of the period
What are some surgical options for menorrhagia if medical management has failed?
Endometrial ablation/resection or hysterectomy
What is the disadvantage to surgical management options for menorrhagia?
They remove fertility
In what age group is dysmenorrhoea most common?
Adolescents and young women
Primary dysmenorrhoea is thought to be associated with excessive production of what by the uterus?
Prostaglandins
What is the most common cause of secondary dysmenorrhoea?
Endometriosis
Uterosacral nodularity and/or tenderness, and a fixed, retroverted uterus on examination is most suggestive of what diagnosis?
Endometriosis
What is adenomyosis?
Endometrial cells are found in the myometrium
Deep dyspareunia, dysmenorrhoea and menorrhagia are most suggestive of what diagnosis?
Endometriosis
What cause of dysmenorrhoea is associated with a history of STIs and chronic pelvic pain?
PID
If an anatomical abnormality is suspected as the cause of dysmenorrhoea, what is the first line investigation?
Trans-vaginal US
What is the gold standard investigation for suspected endometriosis?
Laparoscopy
What are some medical management options for primary dysmenorrhoea?
NSAIDs and hormonal contraceptives
If a woman presents with inter-menstrual or post-coital bleeding, what three investigations should always be done?
Pregnancy test, cervical cytology (if due), high vaginal and endocervical swabs
If a woman presents with inter-menstrual or post-coital bleeding, and findings on examination are suspicious, what imaging investigations are indicated?
Trans-vaginal US and colposcopy
What is the definition of post-menopausal bleeding?
PV bleeding > 12 months after the last menstrual period
What are the two most common, benign causes of post-menopausal bleeding?
Atrophic vaginitis, unscheduled bleeding on HRT
On trans-vaginal US, an endometrial thickness of what would make you suspicious of endometrial cancer? What further investigation would then be indicated?
5mm or more - endometrial biopsy would be the next best investigation
How should post-menopausal bleeding as a result of vaginal atrophy be treated?
Oestrogen pessary or cream
What is the most common cause of post-coital bleeding?
Cervical ectropion
