Heavy Menstrual Bleeding Flashcards
1
Q
What are the major causes of heavy uterine bleeding?
A
- Dysfunctional uterine bleeding (common)
- Systemic causes (endocrine)
- Uterine and local causes (polyps, cancer)
- Iatrogenic (hormonal etc.)
- Pregnancy complications
- Trauma
2
Q
What is the most common kind of dysfunctional uterine bleeding? How does it occur?
A
- Anovulatory (90%) - progesterone not produced, endometrium thickens (unopposed oestrogen) until it outgrows blood supply and becomes necrotic. Proliferative endothelium
Tends to occur at reproductive life extremes. Can increase risk of endometrial carcinoma
3
Q
What systemic pathologies can cause dysfunctional uterine bleeding?
A
- Thyroid disease, PCOS, adrenal disease, weight changes (unopposed oestrogen)
- Bleeding disorders (vWF deficiency most common), liver disease
4
Q
What are the areas you would want to cover in a menstrual history?
A
- First day of LMP
- Cycle length and regularity
- Menarche age
- Quantify blood, clots
- Intermenstrual/post-coital bleeding (infection, pregnancy)
- Last Pap smear
- Anaemic symptoms
- Risk factors (pressure, weight change, acne/hirsuitism, coagulopathc signs, medications [OCP, warfarin, aspirin, NOACs])
5
Q
What are the investigations you might undertake for someone with heavy uterine bleeding?
A
- FBE, iron studies, bHCG
- +/- coags/platelet function/vWF, LH/FSH/oestradiol/androgens, TFTs
- TVUS +/- saline sonohysterogram
- Pipelle endometrial sampling (good for detecting but not ruling out cancer)
- Hysteroscopy with D and C - gold standard for polyps, fibroids
6
Q
What are the treatment principles for heavy uterine bleeding?
A
- Medical
- Non-hormonal (PGs, antifibrinolytic/tranexamic acid)
- Hormonal (OCP, progestogens, Mirena)
- Surgical
- Endometrial ablation - 90% reduction in bleeding, 60% satisfaction at 5 years
- Hysterectomy - total/subtotal +/- ovaries
7
Q
What is the acute treatment for metrostaxis?
A
- ABCDE
- High-dose progesterone
