Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Obstetrics and gynaecology > Heavy menstrual bleeding > Flashcards

Heavy menstrual bleeding Flashcards

1
Q

Describe heavy menstrual bleeding?

A

Excessive (definition set by woman) menstrual loss which interferes with a woman’s quality of life - either on its own or in combination with other symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What percentage of heavy menstrual bleeding cases are found to have no pathology after investigation?

A

40-60%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Dysfunctional/abnormal uterine bleeding?

A

Diagnosis of exclusion

Describe heavy menstrual bleeding for which no cause can be found

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the mnemonic used to classify the causes of heavy menstrual bleeding

A

PALM-COEIN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What does the PALM-COEIN system divide the causes of heavy menstrual bleeding into?

A

Structural (PALM) or non structural (COEIN)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

List the structural causes of heavy menstrual bleeding

A

Polyp
Adenomyosis
Leiomyoma (fibroid)
Malignancy and hyperplasia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

List the non-structural causes of heavy menstrual bleeding

A 
Coagulopathy 
Ovulatory dysfunction
Endometrial 
Iatrogenic 
Not yet classified
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the two main risk factors for heavy menstrual bleeding?

A

Age

Obesity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

At what ages is heavy menstrual bleeding more likely?

A

Menopause

Menarche

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the main clinical features of heavy menstrual bleeding?

A

Bleeding during mensturation deemed excessive for the individual woman

Fatigue

Shortness of breath (anaemia)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What should be asked about in the menstrual history?

A 
Frequency 
Duration 
Volume 
Date of LMP
Smear history 
Contraception
Medical history 
Drug history
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What should be looked for on examination of a woman with heavy menstrual bleeding?

A

General observation - pallor (anaemia)

Abdominal palpation - palpable uterus or pelvic mass, ascertain if the uterus is smooth or irregular (fibroids), tender uterus or cervical excitation point toward adenomyosis/endometriosis

Inflamed cervix/cervical polyp/cervical tumour

Vaginal tumour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is deemed a frequent period?

A

<24 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is deemed infrequent periods?

A

> 38days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the average duration of bleeding?

A

5 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is prolonged menstruation?

A

> 8 days

17
Q

What is shortened menstruation?

A

<4.5 days

18
Q

What is the average volume of menstrual blood lost over course of menses?

A

40ml

19
Q

What is deemed heavy menstrual blood loss

A

> 80ml - hb and ferritin affected, women may describe flooding and clots passable

20
Q

Which coagulopathy is the most common to cause heavy menstrual bleeding?

A

Von Willebrand’s disease

21
Q

What investigations would you do for a patient with heavy menstrual bleeding

A

Urine pregnancy test

Bloods - FBC, TFTs, Hormone testing (eg. for PCOS), Coagulation screen and test for von willebrand’s

Ultrasound pelvis - Transvaginal US is most clinically useful for assessing the endometrium and ovaries

Cervical smear if not up to date

High vaginal and endocervical swabs

Pipelle endometrial biopsy

Hysteroscopy and endometrial biopsy

22
Q

What are the indications for a pipelle endometrial biopsy?

A

Persistent intermenstrual bleeding
>45years old
Failure of pharmacological treatment

23
Q

What is the aim of managing heavy menstrual bleeding?

A

Improve the woman’s quality of life rather than specific reduction in the volume of blood lost

24
Q

Describe the 3 tiered approach to treating heavy menstrual bleeding with pharmacological management

A

Levonorgestrel releasing intrauterine system (LNG-IUS)

Tranexamic acid, mefenamic acid or combined oral contraceptive pill

Progesterone only: oral norethisterone (taken day 5-26) of cycle, depo or implant

25
Q

What are the two main treatment options for heavy menstrual bleeding?

A

Endometrial ablation

Hysterectomy

26
Q

Describe endometrial ablation

A

Where the endometrial lining of the uterus is obliterated

27
Q

Who is endometrial ablation suitable for?

A

Women who no longer wish to conceive - although they will still need to use contraception

28
Q

How much can heavy menstural bleeding be reduced by when using ablation?

A

80%

29
Q

What is the definitive treatment for heavy menstural bleeding?

A

Hysterectomy

30
Q

What does hysterectomy offer?

A

Amenorrhoea

End to fertility

31
Q

What are the two types of hysterectomy?

A

Subtotal (partial)

Total

32
Q

What is a subtotal hysterectomy?

A

Removal of the uterus but not cervix

33
Q

What is a total hysterectomy?

A

Removal of cervix with uterus

34
Q

Are the ovaries removed in subtotal or total hysterectomy?

A

No - unless abnormal

35
Q

How is hysterectomy performed?

A

Abdominal incision

Via vagina

Obstetrics and gynaecology (67 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions