Heavy Menstrual Bleeding Flashcards
What are the causes of HMB?
P = polyps A = adenomyosis L = leiomyoma/ fibroids M = malignancy and hyperplasia C = coagulopathy e.g. Von Willebrand's disease, liver disease O = ovarian dysfunction e.g. PCOS, hypothyroid, hyperprolactinaemia, anorexia E = endometrial dysfunction e.g. endometriosis, PID I = iatrogenic N = not yet classified
What is the definition of HMB?
Prolonged menses (>7days) or excessive bleeding (loss >80ml) occurring at regular intervals
How do polyps present?
Often asymptomatic, found on hysteroscopy
What is the Ix for adenomyosis?
U/S - increased echogenicity within myometrium, myometrial hypertrophy, dilated glands
What is the treatment for adenomyosis?
Do nothing
Hormonal - OCP, IUD to reduce flow
Hysterectomy
How might fibroids present?
Often asymptomatic
May present with pressure Sx, frequency
What are fibroids?
Benign fibromuscular tumours that increase SA of endometrium so more to bleed from
What are Cx of fibroids?
Subfertility
If on a stalk can tort and infarct
What is the treatment for fibroids?
Do nothing Hormonal - OCP, IUD to reduce flow Hysterscopic resection if submucous Myomectomy Hysterectomy
What types of malignancy may cause HMB and how are they found?
Endometrial cancer - dx on endometrial sampling
Cervical cancer - dx on PAP smear/ HPV testing or colposcopy
What types of coagulopathy may cause HMB?
Von Willebrand’s disease
Plt dysfunction disorder
Factor deficiencies: V, IX, X
What are some causes of ovulatory dysfunction?
Thyroid (hypo/hyper)
Pituitary/ adrenal disease
PCOS
Significant weight loss
What is the treatment for polpys?
Do nothing
Hormonal - OCP, IUD to reduce flow
Hysteroscopic polypectomy
Hysterectomy
What are some iatrogenic causes of HMB?
OCP
IUD
Chemotherapy
Anticoagulation
Other causes of HMB?
Endometritis
Pregnancy Cx- ectopic, miscarriage
