Gynaecology & Breast Flashcards
What proportion of women aged 30-49 present to their GP each year for help with heavy menstrual bleeding or menstrual problems?
1 in 20
What one investigation is indicated for all women complaining of heavy menstrual bleeding?
FBC
When are TFTs recommended to be checked in a woman with heavy menstrual bleeding?
If there are additional signs and symptoms of thyroid disease
When is a coagulation profile recommended to be checked in a woman with heavy menstrual bleeding?
If the problem is lifelong or there is family hx of bleeding disorder
When might an ultrasound scan be recommended in a woman with heavy menstrual bleeding?
If there are symtpoms/signs of uterine enlargement e.g. pressure symptoms affecting bladder
If an ultrasound is requested for heavy menstrual bleeding, which method of ultrasound is preferred?
Trans-vaginal
When is hysteroscopy recommended for investigation of heavy menstrual bleeding?
With a history of intermenstrual bleeding to check for fibroids/polyps
What are the potential iatrogenic causes of heavy menstrual bleeding?
-Anticoagulants
-Copper IUD
What is the PALM-COEIN classification system?
Classification system for causes of abnormal uterine bleeding
What are the structural causes of abnormal uterine bleeding as per PALM-COEIN classification?
Polyp
Adenomyosis
Leiomyoma
Malignancy and hyperplasia
What are the non-structural causes of abnormal uterine bleeding as per PALM-COEIN classification?
Coagulopathy
Ovulatory dysfunction
Endometrial
Iatrogenic
Not yet classified
What non-hormonal methods can be used to managed heavy menstrual bleeding?
Tranexamic acid
NSAIDs
What hormonal methods can be used to managed heavy menstrual bleeding?
-Levonorgestrel-releasing IUS
-Combined hormonal contraception
-Long-cycle progestogens (oral or depot)
What method of treatment for heavy menstrual bleeding causes the largest decrease in menstrual blood flow?
Levonorgestrel-releasing IUS - up to 96% reduction
If methods in primary care do not work to manage heavy menstrual bleeding, or are not suited to the patient, what can the patient be referred for?
Endometrial ablation
What are the 2 main benefits of endometrial ablation for heavy menstrual bleeding?
-Highly effective & minimally invasive
-Quick recovery post procedure
Can endometrial ablation be reversed?
No
Is amenorrhoea guaranteed after endometrial ablation?
No - depends on the technique used
What does the patient need to be informed regarding pregnancy after endometrial ablation?
High risk for miscarriage and placenta accreta
When does endometrial hyperplasia occur?
When oestrogen stimulates endometrial cell growth unopposed by progesterone
Is endometrial hyperplasia a pre-malignant condition?
Yes
Why is the occurrence of endometrial cancer increasing?
Due to increasing rates of obesity
What is the biggest preventable risk factor for endometrial cancer?
Obesity
What is a leiomyoma?
A fibroid - tumours of the myometrium
