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Heavy Menstrual Bleeding Flashcards

1
Q

What is Heavy Menstrual Bleeding?

A

Excessive menstrual loss which interferes with a woman’s quality of life

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2
Q

What percentage of women experience Heavy Menstrual Bleeding?

A

3%

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3
Q

What age group of women are most affected by Heavy Menstrual Bleeding?

A

40-51 years old

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4
Q

What is the mnemonic used to divide the different causes of Heavy Menstrual Bleeding?

A

Palm-Coein

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5
Q

What does the PALM bit of the Palm-Coein mnemonic mean?

A

Structural causes of Heavy Menstrual Bleeding:

P – Polyp

A – Adenomyosis

L – Leiomyoma (Fibroid)

M – Malignancy / hyperplasia

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6
Q

What does the COEIN bit of the Palm-Coein mnemonic mean?

A

Non-structural causes of Heavy Menstrual Bleeding:

C – Coagulopathy

O – Ovulatory dysfunction

E – Endometrial

I – Iatrogenic

N – Not yet classified

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7
Q

What are the main risk factors for Heavy Menstrual Bleeding? (2 things)

A
  1. Age
  2. Obesity
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8
Q

What are the CF of Heavy Menstrual Bleeding? (3 things)

A
  1. Bleeding
  2. Fatigue
  3. SOB (if associated anaemia)
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9
Q

What are you looking for @ examination of Heavy Menstrual Bleeding patient? (4 things)

A
  1. Pallor (anaemia)
  2. Palpable uterus / pelvic mass
  3. Inflamed cervix / cervical polyp / tumour
  4. Vaginal tumour
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10
Q

What are you suspecting if a Heavy Menstrual Bleeding patient has an irregular uterus @ examination?

A

Fibroids

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11
Q

What are you suspecting if a Heavy Menstrual Bleeding patient has a tender uterus / cervical excitation @ examination? (2 things)

A
  1. Adenomyosis
  2. Endometriosis
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12
Q

What are the differential diagnoses for Heavy Menstrual Bleeding? (9 things)

A
  1. Pregnancy
  2. Endometrial / cervical polyps
  3. Adenomyosis
  4. Fibroids
  5. Malignancy / endometrial hyperplasia
  6. Coagulopathy
  7. Ovarian dysfunction
  8. Iatrogenic causes
  9. Endometriosis
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13
Q

What are the CF of Endometrial / cervical polyps? (3 things)

A
  1. Intermenstrual bleeding
  2. Post-coital bleeding
  3. NOT associated w dysmenorrhea (painful periods)
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14
Q

What are the CF of Adenomyosis? (2 things)

A
  1. Dysmenorrhea
  2. Bulky uterus (@ exam)
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15
Q

What are the CF of Fibroids? (2 things)

A
  1. Hx of pressure symptoms (e.g urinary frequency)
  2. Bulky uterus (@ exam)
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16
Q

What is the most common Coagulopathy to cause Heavy Menstrual Bleeding?

A

Von Willebrand’s disease

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17
Q

What are the CF of Von Willebrand’s disease? (5 things)

A
  1. HMB since menarche
  2. PPH Hx
  3. Surgical / dental related bleeding (bleeding gums)
  4. Easy bruising / epistaxis
  5. Bleeding disorder FHx
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18
Q

What should you consider for pt w Von Willebrand’s disease?

A

Warfarin (anti-coagulant)

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19
Q

What are the most common causes of Ovarian dysfunction? (2 things)

A
  1. PCOS
  2. Hypothyroidism
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20
Q

What are the iatrogenic causes of HMB? (2 things)

A
  1. Contraceptive hormones
  2. Copper IUD
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21
Q

What percentage of all HMB does Endometriosis represent?

A

Less than 5%

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22
Q

What investigations should you do for HMB? (5 things)

A
  1. Urine pregnancy test
  2. FBC
  3. TFT
  4. Hormone tests (e.g if sus PCOS)
  5. Coag screen (+ check for Von Willebrand’s) if sus
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23
Q

Why should you do a FBC for HMB?

A

Anaemia presents after 120ml menstrual blood loss

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24
Q

When should you do a TFT for HMB?

A

If has other signs of hypothyroidism

25
What imaging should you do for HMB?
Transvaginal US
26
What is a Transvaginal US useful for?
Checking endometrium / ovaries
27
When should you for a Transvaginal US in HMB? (2 things)
1. Uterus / pelvic mass palpable @ exam 2. Pharmacological tx failed
28
When should you do a Cervical smear in HMB?
If hasn’t had routine ones done
29
What investigation should you for HMB if sus infection?
High vaginal / endocervical swabs
30
What biopsy can be done for HMB?
Pipelle endometrial biopsy
31
When should you do a Pipelle endometrial biopsy in HMB? (3 things)
1. Persistent intermenstrual bleeding 2. 45+ age 3. Pharmacological tx failed
32
When should you do a Hysteroscopy / Endometrial biopsy for HMB?
US identifies pathology / is inconclusive
33
What is the aim of management of HMB?
Improve woman’s quality of life (rather than specific reduction in blood loss volume)
34
When considering HMB management options, what should you discuss with the patient?
Impact on fertility
35
What is the management approach for HMB when there is no sus pathology?
3 tiered approach
36
What is the 3 tiered approach for HMB?
1. Levonorgestral-releasing intrauterine system (LNG-IUS) 2. Tranexamic acid / Mefanamic acid / COCP 3. Progesterone only: Oral Norethisterone / Depo / Implant
37
What does Levonorgestral-releasing intrauterine system (LNG-IUS) also act as?
Contraceptive
38
How long is Levonorgestral-releasing intrauterine system (LNG-IUS) licenced for treatment?
5 years
39
How does Levonorgestral-releasing intrauterine system (LNG-IUS) work? (2 things)
1. Thins endometrium 2. Shrinks fibroids
40
What does the woman’s choice to use Tranexamic acid / Mefanamic acid / COCP depend on?
Her wishes for fertility
41
When should Tranexamic acid be used?
Only during menses to reduce bleeding
42
Does Tranexamic acid have an effect on fertility?
No
43
What is a pro for using Mefanamic acid?
Is an NSAID = offers analgesia for dysmenorrhoea
44
When should Mefanamic acid be used?
Only during menses to reduce bleeding
45
Does Mefanamic acid have an effect on fertility?
No
46
Does Oral Norethisterone work as a contraceptive?
No
47
Do Depo / Implant progesterone work as a contraceptive?
Yes
48
What are the main Surgical management options for HMB? (2 things)
1. Endometrial ablation 2. Hysterectomy
49
What are some other Surgical management options only for HMB caused by fibroids? (2 things)
1. Myomectomy 2. Uterine artery embolization
50
What is Endometrial ablation?
Lining of uterus obliterated
51
Who is Endometrial ablation suitable for?
Women who no longer wish to conceive
52
By how much does Endometrial ablation reduce HMB?
Up to 80%
53
Where can Endometrial ablation be performed?
Outpatient using local anaesthetic
54
What is the only definitive treatment for HMB?
Hysterectomy
55
What does Hysterectomy offer? (2 things)
1. Amenorrhoea 2. End to fertility
56
What are the types of Hysterectomy performed? (2 things)
1. Subtotal (partial) 2. Total
57
What is Subtotal (partial) Hysterectomy?
Removal of uterus but NOT cervix
58
What is Total Hysterectomy?
Removal of uterus and cervix
59
What openings can Hysterectomy be performed via? (2 things)
1. Abdominal incision 2. Vagina

Y4 Reproductive Health (27 decks)

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