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MRCOG - Part 2 > Heavy Mens. Bleeding > Flashcards

Heavy Mens. Bleeding Flashcards

1
Q

Average blood loss during menses

A

30-40 ml

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2
Q

Blood loss in HMB

A

> 80 ml

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3
Q

How many women describes her menses as heavy

A

One Third of women

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4
Q

first thing to investigate in abnormal uterine bleeding in childbearing women

A

Exlude pregnancy (bhcg test)

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5
Q

AUB before puberty may be?

A
  • foreign body
  • precocious puberty
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6
Q

AUB in post menopausal women

A
  • atrophic vaginitis/endometritis (common)
  • endometrial hyperplasia/ cancer (serious)
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7
Q

Causes of AUB

A

FIGO classification
DUB IDIOPATHIC: 40-60%

Non structural (COEIN)
1. Coagulation disorders (vonWillberand dis)
2. Ovulation disorders (PCOs)
3. Endometrial disorders
4. Iatrogenic (anticoagulants-chemotherapy- IUCD)
5. Non specific (HTN-Liver troubles- hypothyroidism)

Structural: PALM
1. Polyps
2. Adenomyosis
3. Leiomyomas
4. Malignancy (end. Cx. Ovarian)

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8
Q

HOW IUCD cause AUB

A

Blood loss may increase 40-60% over 6-12 months

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9
Q

Risks and complications of HMB

A

• Affects QOL by limiting normal activities, social life, and work.
• Woman’s sex life may be negatively affected.
• Mood changes.
• Iron deficiency anaemia in about two thirds of women.

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10
Q

Which history along with HMB suggests the presence of an intrauterine or uterine pathology?

A
  • Intermenstrual bleeding
  • Pelvic pain
  • pressure symptoms
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11
Q

Which history along with that of HMB suggests the presence of an intrauterine or uterine pathology?

A

Intermenstrual bleeding
Pelvic pain or pressure symptoms

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12
Q

Is physical examination mandatory for all HMB patients ?

A

No - not if the only complaint is HMB

To be done - only if intermensterual bleeding,pelvic pain or pressure symptoms present & before fitting LNG IUS

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13
Q

Which lab investigations are done in cases of HMB

A

CBC - for all HMB

Coagulation tests - if HMB since menarche and positive personal or family history for coagulation disorders

Thyroid - only if signs and symptoms present

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14
Q

Which is the 1st line investigation if you suspect an intrauterine pathology - like endometrial pathology, polyp, submucosal fibroid ?

A

Outpatient hysteroscopy

If shed declines Offer under SA or GA

If declines that also, TVS. But explain the limitations

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15
Q

Should blind endometrial sampling be taken investigating HMB

A

No

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16
Q

When is TVS the 1st line investigation for HMB

A

Palpable uterus
Pelvic mass suspected on history or examination
Obese patient

If she declines:
TAS or MRI
Explain the limitations

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17
Q

1st line management for females with only HMB. No pathology?

A

LNG IUS

Also for adenomyosis and fibroids < 3 cm

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18
Q

What if women with no pthological HMB DECLINDES LNG-IUS

A

-Non hormonal
-Hormonal

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19
Q

What if women with no pathological HMB refused pharmaceutical options

A

Surgical - 2nd line endometrial ablation
Hysterectomy

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20
Q

Management of large fibroids

A

Non hormonal
Hormonal
UAE
Surgical - Myomectomy, Hysterectomy

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21
Q

2nd line medical treatment in HMB

A

Trenaxemic acid + NSAIDS

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22
Q

When NSAIDS AND TRENEXAMIC ACID indicated in treating HMB

A
  • If hormonal treatments are not acceptable to the woman.
  • If contraception is not desired.
  • Can be commenced as first-line drugs while investigations or definitive treatment is being organized.
23
Q

How long she could take trenaxemic acid in ttt of HMB

A

Ongoing use is recommended for as long as they are found to be beneficial.

24
Q

When use of trenaxemic acid should be stoped when ttt HMB

A

Use should be stopped if it does not improve symptoms within three menstrual cycles.

25
Q

Third line medical management of HMB

A
  • Oral norethisterone (NET, 15 mg) daily from D5–26: not used if pregnancy desired (steronate)
  • Depot medroxyprogesterone acetate (DMPA): bleeding stops completely
  • don’t use oral progestogens used in luteal support in ttt of HMB
26
Q

What is TXA (trenaxemic acid)

A

Anti fibrinolytic = kapron

27
Q

Typical dose of TXA

A

500 mg Tds on bleeding days

28
Q

SE of TXA

A

indigestion, diarrhoea, headaches.

29
Q

How do COCs ttt HMB

A

suppresses ovulation and endometrial proliferation, thereby decreasing menstrual fluid volume and prostaglandin secretion; regulates cycles.

30
Q

Indications of COCs use

A
  • HMB.
  • Dysmenorrhoea.
  • Contraceptive.
31
Q

Indications of COCs use

A
  • HMB.
  • Dysmenorrhoea.
  • Contraceptive.
32
Q

SE of COCs

A

mood changes, headaches, nausea, fluid retention, breast tenderness, DVT, stroke, heart attacks.

33
Q

Mechanism of action of GNRHa

A

stops ovarian production of oestrogen and progesterone. In 89% of women, bleeding stops completely.

34
Q

GNRH-a indications in case of HMB

A

could be considered prior to surgery or when all other treatment options for uterine fibroids, including surgery or UAE, are contraindicated.

35
Q

Typical dose of GNRH-a in treating of HMB

A

3.6 mg implant every 4 weeks.

36
Q

Gnrh-a SE

A
  • menopausal symptoms
  • vaginal dryness
  • osteoporosis, particularly trabecular bone

with longer than 6 months use.

37
Q

Do we need giving ERT after GNRHa

A

If this treatment is to be used for > 6 months or if adverse effects are experienced, then HRT ‘add-back’ therapy is recommended.

38
Q

Oral norethisterone mechanism of action in ttt of HMB

A

(Progestogens) prevents proliferation of the endometrium.

39
Q

Oral norethisterone typical dose

A

15 mg daily from D5 to D26.

40
Q

Oral norethisterone SE

A

weight gain, bloating, breast tenderness, headaches, acne, depression.

41
Q

Mode of action of LNG-IUD

A

slowly releases progestogen locally and prevents proliferation of the endometrium.

42
Q

Duration of effect of LNG-IUD

A

5 years

43
Q

LNG-IUD INDICATIONS

A
  • HMB.
  • Contraceptive.
  • Endometriosis.
44
Q

LMG-IUD side effects

A

irregular bleeding that may last for over 6 months
hormone-related problems such as breast tenderness, acne, or headaches (minor and transient)
amenorrhoea
uterine perforation at the time of IUD insertion.

45
Q

Mechanism of action of DMPA

A

it is a long-acting progestogen. Works primarily by suppressing ovulation; prevents proliferation of the endometrium.

46
Q

Mechanism of action of DMPA

A

it is a long-acting progestogen. Works primarily by suppressing ovulation; prevents proliferation of the endometrium.

47
Q

DMPA typical dose in ttt HMB

A

IM injection every 12 weeks

48
Q

DMPA side effects

A

weight gain
irregular bleeding
amenorrhoea
premenstrual-like syndrome
small loss of bone mineral density
largely recovered when treatment is discontinued.

49
Q

Surgical options in treating HMB, normal uterus with or without fibroid <3 cm

A

Endometrial ablation

50
Q

Surgical options in treating HMB, uterus with fibroid >3cm

A

Uterine artery Embolization
Myomectomy

51
Q

How does endometrial ablation works

A

Removes or destroys the womb lining and stops heavy bleeding. Results in clinically relevant reduction in bleeding and improvement in QOL.

52
Q

HMB accounts for how many outpatient referrals to gynaecology?

A

20%

53
Q

SBA

What is the 1ry aim of medical intervention in management of HMB

A

Improving women’s QOL

54
Q
A

MRCOG - Part 2 (44 decks)

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