Expert Forum

Question 1

What is the definition of post-menopausal bleeding?

Answer 1

Vaginal bleeding >12 months after LMP

Question 2

What is the commonest cause of post menopausal bleeding?

Answer 2

Atrophic vaginitis - dried out vagina as no more oestrogen to keep it nice and healthy

Question 3

What investigation should you do for post menopausal bleeding

Answer 3

Trans vaginal US to look for endometrial cancer

Question 4

How would you surgically treat endometrial cancer?

Answer 4

TAH + Bilateral Salpingo-oophorectomy

Question 5

What are the three HRT regimes?

Answer 5

Oestrogen only

Sequential - Oestrogen daily with progestogen for 14days/month

Continuous combined

Question 6

What HRT regime is a monthly withdrawal bleed suggestive of?

Answer 6

Sequential as stopping progestogen at beginning of every month → bleed

Question 7

What is required to start the continuous combined HRT regime?

Answer 7

LMP > 1 year ago

as uterus needs to be atrophic and not bleed

Question 8

How are mifepristone and misoprostol given for termination of pregnancy?

Answer 8

Mifepristone → termination

48hr later Misoprostol (prostaglandin analgue) → expel products

Question 9

What is used for late termination? 21+ weeks

Answer 9

Inject KCL into heart of foetus

Surgical evacuation of retained products of conception

Question 10

What is a commonly used combined oral contraceptive fill?

Answer 10

Microgynon

Question 11

What are progesterone only pills useful for?

Answer 11

Not good for heavy periods

But stop heavy bleeding temporarily → good for correcting irregular periods