Disorders of Menstrual bleeding Flashcards
What are causes of heavy menstrual bleeding (structural and non structural)?
PALM COEIN
Polyps
Adenomyosis
Leiomyoma
Malignancy
Coagulopathy Ovulatory disorders Endometrial Iatrogenic Not classified
Define Heavy Menstrual Bleeding
Blood loss >80mL per period
OR whatever the patient classifies as bering abnormally heavy
How do you investigate HMB?
Abdominal and pelvic exam
FBC, TFT Coagulation screen Pelvic USS High vaginal/endocervical swabs Endometrial biopsy Hysteroscopy
What are indications for endometrial biopsy in HMB?
PMB + endometrial thickness on TVUSSS >4mm
HMB >45 years
HMB associated with IMB
Treatment failure
What are indications for hysteroscopy in HMB?
Endometrial biopsy fails
Endometrial biopsy sample is insufficient
TVUSS is inconclusive
Abnormality of TVUSS is amenable to treatment
What is the medical management of HMB?
Levonorgestrel Intrauterine System (LNG-IUS, Mirena) Tranexamic acid Mefenamic acid (NSAID) Norethisteore GnRH agonist
When should tranexamic acid be taken?
During menstruation
When should norethisterone be taken?
day 6-26 of menstrual cycle
How long should GnRH agonist be taken for?
ONLY in SHORT TERM
What is a risk of taking GnRH agonist?
OSREOPOROSIS
What is surgical management of HMB?
Endometrial ablation Uterine artery embolisation Myomectomy Transcervical resection of fibroid Hysterectomy
Who is surgical management of HMB allowed in?
Women who are CERTAIN that their family is complete
Women wishing to preserve fertility should only use MEDICAL OPTIONS
What is endometrial ablation?
Ablation of the endometrium to a sufficient depth to prevent regeneration
How do you manage ACUTE HMB?
- Admit
- Pelvic examination
- FBC, coat screen, biochem
- IV access, fluid resuscitations
- Tranexemic acid (PO/IV)
- TVUSS
- High dose progesterone to arrest bleeding
- Consider suppression with GnRH; ulipristal acetate
What is dysmenorrhoea?
Painful menstruation
What are common causes of secondary dysmenorrhoea=
PACE
PID
Adenomyosis
Cervical stenosis/haematometra
Endometriosis
What is Ix for dysmenorrhoea?
High vaginal, endocervical swabs
TVUSS
Diagnostic laparoscopy
What is management of dysmenorrhoea?
Conservative - lifestyle changes (diet, exercise), heat
Medications: NSAIDS, COCP (LNG-IUS)
What are iatrogenic causes of abnormal bleeding?
Iatrogenic:
- Progesterone contraception
- Traumatic uterine perforation
What questions should you ask about bleeding heaviness=?
- How often do you change your tampons/pads
- Flooding
- Clotting
What are causes of HMB?
Fibroids
Adenomyosis / endometriosis
Endometrial polyp
Gynae:
- PID
- Endometrial/cervical carcinoma
- PID
Other:
- Coag disorders (vWD)
- Drug therapy (warfarin)
- Thyroid disease
