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Obstetrics & Gynaecology BAB > Gynae:HMB/IMB > Flashcards

Gynae:HMB/IMB Flashcards

1
Q

Another name for HMB

A

Menorrhagia

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2
Q

Give a definition for HMB

A

Excessive bleeding in an otherwise normal menstrual cycle >80mls/month

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3
Q

State the clinical definition

A

Excessive menstrual loss that interferes with a women’s physical, emotional and social quality of life

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4
Q

What is HMB mainly caused by ?

A

Dysfunctional uterine Bleeding is no other cause found

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5
Q

With regards to gynae causes/DDx, state the 2 main causes of HMB ?

A

Fibroids and polyps (cervical or endometrial)

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6
Q

With regards to gynae causes/DDx, state the 3 other causes of HMB ?

A

Endometriosis, adenomyosis and cancer(ovarian, cervical and endometrial)

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7
Q

What are the other causes of HMB ? (3)

A

Hypothyroidism, Von Willebrands Disease and anaemia

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8
Q

What in the menstrual history is indicative of excessive loss ?

A

Flooding and clots

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9
Q

For investigations:

Which bloods would you do ? (3)

A

FBC (Hb, B12)
TFTs (hypothyroidism)
Coagulation screen (VWD)

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10
Q

What are the main investigations ?

A 
Transvaginal Ultrasound scan 
Endometrial biopsy (OP pipelle in combination with hysteroscopy) if specific requirements are made
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11
Q

When should endometrial biopsies be taken with regards to HMB ?

A
  1. In those over 40
  2. With no response to medical therapy
  3. Significant IMB (HMB with IMB) or resulting in acute admission
  4. TVUSS shows polyps or endometrial thickening (perform Hysteroscopy)
  5. RFs for endometrial cancer: ENDOMET
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12
Q

What are the risk factors for endometrial cancer ? 😂

A

Elderly
Nulliparity
Diabetes and Lynch type 2 syndrome
Obesity
Menstrual irregularities: early menarche and late menopause
Estrogen therapy (unopposed oestrogen and tamoxifen) + PCOS
hyperTension

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13
Q

What shouldn’t you forget to ask about in a PMH for HMB ?

A

Bleeding disorders

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14
Q

What is important to establish when starting treatment for HMB ?

A

If the Women is trying to conceive

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15
Q

What is the first line treatment ?

A

Mirena IUS

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16
Q

What are the second line treatments ?

A

NSAIDs e.g mefenamic acid, antifibronlytic: tranexamic acid & COCP

17
Q

What are the 3rd line treatments for HMB ?

A

Progestogen (high dose oral or IM)

GnRH analogues

18
Q

What would be the first line-treatment if patient was trying to conceive ?

A

NSAIDs or tranexamic acid

19
Q

Whom is surgery reserved for ?

A

For those that do not respond to medical therapy

20
Q

What 2 groups can Surgery be split into ?

A

Hysteroscopy and radical e.g. hysterectomy

21
Q

What are the 3 types of surgery that can be performed under hysteroscopy ? 😂

A
  1. Polp removal, 2. Endometrial ablation techniques and 3. Transcervical resection of fibroids
22
Q

What are the 3 types of radical surgery that can be performed?

A

Hysterectomy, myomectomy & uterine artery embolisation

23
Q

When is a myomectomy and ; UAE performed ?

A

Myomectomy: complete removal of fibroids

UAE

24
Q

What may IMB/Irregular Bleeding co-exist with ?

A

Heavy menstrual Bleeding

25
Q

What are the 5 common causes/DDx with regards to irregular menstrual Bleeding ?

A

Cervical/endometrial polyps, ovarian cyst, chronic pelvic infection (PID), fibroids and adenomyosis

26
Q

What are the 2 common causes found in the elderly ?

A

Endometriosis and cancer: ovarian and cervical. Less commonly: Endometrial

27
Q

What is the first line management ?

A

Mirena IUS or COCP

28
Q

What is the 2nd line treatment ?

A

Progestogen: DEPO, HRT & other 2nd line HMB

29
Q

What is the surgical treatment ?

A

Same as HMB except that ablative techniques are less helpful

30
Q

What else can result in IMB/irregular bleeding ?

A

Medication

31
Q

What medication can also result in IMB ?

A

IUCD, aspirin, warfarin

32
Q

What medication cause HMB/IMB ?

A

IUCD

Obstetrics & Gynaecology BAB (25 decks)

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