Heavy Menstrual Bleeding Flashcards
1
Q
DDx of Heavy Menstrual Bleeding
A
PALM-COEIN Polyps Adenomyosis Leiomyoma Malignancy/hyperplasia Coagulopathy Ovulatoiry dysfunction Endometrial Iatrogenic Not yet classified
2
Q
Most common cause of HMB
A
Dysfunctional Uterine Bleeding
ovulatory and anovulatory
3
Q
Risk factors for dysfunctional uterine bleeding
A
- Extremes of reproductive life (adolescence 20% and perimenopause 50%)
- although can occur at any time
4
Q
Complications of HMB
A
- Iron deficiency anaemia
- Infertility
- chronic DUB increases risk of endometrial CA
5
Q
Endocrine causes of DUB
A
- thyroid (hypo OR hyper)
- pituitary of adrenal
- PCOS
- significant weight change
6
Q
risk factors for fibroids
A
- nulliparous
- obesity
- positive FHx
- African-American
7
Q
factors that decrease risks of fibroids
A
- grand multiparity
- post-menopausal
- smoking
- prolonged OCP use
8
Q
Symptoms of fibroids
A
- often asymptomatic
- heavy bleeding
- frequent urination
- dyspareunia
- lower back pain
- complications in pregnancy and labour (pain, ? spontaneous miscarriage, and 6x caesarian rate)
9
Q
Management of fibroids
A
- nil if asymptomatic/small
- Myomectomy (fertility preserved)
- hormonal therapy (GnRH agonists)
- Hysterectomy
10
Q
Symptoms of adenomyosis
A
menorrhagia
dysmenorrhoea
bulky, tender uterus
dyspareunia
11
Q
Management of adeomyosis
A
Induce amenorrhoea (OCP, Mirena)
GnRH analogues
Hysterectomy
12
Q
Management of heavy menstrual bleeding
A
(Treat underlying cause) Medical Therapy -Mefanamic acid (PG inhibitor) -Tranexamic acid (antifibrinolytic) -OCP -Progestogens Surgical Therapy -endometrial ablation (laser/diathermy) -hysterectomy
13
Q
Define metrostaxis
A
Acute menstrual blood loss causing haemodynamic instability
14
Q
Management of metrostaxis
A
- Resuscitation (IVT)
- CONSIDER: Pregnancy, PPH, genital tract trauma, coagulopathy, AVM, CA
- Commonest cause is DUB
- Acute phase Mx use high dose progestogens with high dose OCP
