Bleeding

Question 1

Intermenstrual Bleeding:

Cervical causes - 3
- What STI can cause cervicitis which leads to IMB?

Uterine causes - 3

What type of pregnancy may cause this?

Why is it important to ask about recent contraception?

Answer 1

Ectropion
Cancer
Polyps

Chlamydia

Fibroids
Endometrial cancer
Polyps

Ectopic pregnancy

You can get ‘breakthrough bleeding’ mid-cycle when new contraception has been started.
It is more common in low/no oestrogen pills.

Question 2

Post-coital Bleeding:

It is usually due to cervical disease.

Name a few examples of cervical disease - 2

May also be due to cancer. Where may the cancer be? - 3

Cervicitis is another one that presents with PCB. What else might you see alongside this?

What do you need to be mindful of in older women that you’d probably see on examination?

Answer 2

Ectropion
Polyps

Cervical, endometrial or vaginal cancer

Polyps

White, yellow or green discharge - chlamydia

Vaginal atrophy - caused by low oestrogen levels -

Question 3

Post-menopausal bleeding:

When is it classed as post-menopausal?

It must be considered as _____ before being ruled out anything else. Fill the gap?

Endometrial causes - 2
Fibroids - what type may lead to PMB?

Something that happens in menopause?

What may the elderly confuse PMB for?

It may also be a side effect of HRT. Why is that?

Answer 3

> 1 yr since LMP

Endometrial carcinoma

Endometrial hyperplasia
Endometrial polyps

Submucosal fibroids

Vaginal atrophy - inflammation and thinning of the vaginal lining (atrophic vaginitis) or womb lining (endometrial atrophy)

Urethral or rectal bleeding

Leads to endometrial hyperplasia.
It’s usually the result of too much estrogen and not enough progesterone