Gynae:HMB/IMB Flashcards
Another name for HMB
Menorrhagia
Give a definition for HMB
Excessive bleeding in an otherwise normal menstrual cycle >80mls/month
State the clinical definition
Excessive menstrual loss that interferes with a women’s physical, emotional and social quality of life
What is HMB mainly caused by ?
Dysfunctional uterine Bleeding is no other cause found
With regards to gynae causes/DDx, state the 2 main causes of HMB ?
Fibroids and polyps (cervical or endometrial)
With regards to gynae causes/DDx, state the 3 other causes of HMB ?
Endometriosis, adenomyosis and cancer(ovarian, cervical and endometrial)
What are the other causes of HMB ? (3)
Hypothyroidism, Von Willebrands Disease and anaemia
What in the menstrual history is indicative of excessive loss ?
Flooding and clots
For investigations:
Which bloods would you do ? (3)
FBC (Hb, B12)
TFTs (hypothyroidism)
Coagulation screen (VWD)
What are the main investigations ?
Transvaginal Ultrasound scan Endometrial biopsy (OP pipelle in combination with hysteroscopy) if specific requirements are made
When should endometrial biopsies be taken with regards to HMB ?
- In those over 40
- With no response to medical therapy
- Significant IMB (HMB with IMB) or resulting in acute admission
- TVUSS shows polyps or endometrial thickening (perform Hysteroscopy)
- RFs for endometrial cancer: ENDOMET
What are the risk factors for endometrial cancer ? 😂
Elderly
Nulliparity
Diabetes and Lynch type 2 syndrome
Obesity
Menstrual irregularities: early menarche and late menopause
Estrogen therapy (unopposed oestrogen and tamoxifen) + PCOS
hyperTension
What shouldn’t you forget to ask about in a PMH for HMB ?
Bleeding disorders
What is important to establish when starting treatment for HMB ?
If the Women is trying to conceive
What is the first line treatment ?
Mirena IUS
What are the second line treatments ?
NSAIDs e.g mefenamic acid, antifibronlytic: tranexamic acid & COCP
What are the 3rd line treatments for HMB ?
Progestogen (high dose oral or IM)
GnRH analogues
What would be the first line-treatment if patient was trying to conceive ?
NSAIDs or tranexamic acid
Whom is surgery reserved for ?
For those that do not respond to medical therapy
What 2 groups can Surgery be split into ?
Hysteroscopy and radical e.g. hysterectomy
What are the 3 types of surgery that can be performed under hysteroscopy ? 😂
- Polp removal, 2. Endometrial ablation techniques and 3. Transcervical resection of fibroids
What are the 3 types of radical surgery that can be performed?
Hysterectomy, myomectomy & uterine artery embolisation
When is a myomectomy and ; UAE performed ?
Myomectomy: complete removal of fibroids
UAE
What may IMB/Irregular Bleeding co-exist with ?
Heavy menstrual Bleeding
What are the 5 common causes/DDx with regards to irregular menstrual Bleeding ?
Cervical/endometrial polyps, ovarian cyst, chronic pelvic infection (PID), fibroids and adenomyosis
What are the 2 common causes found in the elderly ?
Endometriosis and cancer: ovarian and cervical. Less commonly: Endometrial
What is the first line management ?
Mirena IUS or COCP
What is the 2nd line treatment ?
Progestogen: DEPO, HRT & other 2nd line HMB
What is the surgical treatment ?
Same as HMB except that ablative techniques are less helpful
What else can result in IMB/irregular bleeding ?
Medication
What medication can also result in IMB ?
IUCD, aspirin, warfarin
What medication cause HMB/IMB ?
IUCD
