Heavy menstrual bleeding

Question 1

What are the four features of heavy menstrual bleeding that would make you concerned about malignancy?

Answer 1

Inter-menstrual bleeding, post coital bleeding, post menopausal bleeding and presence of associated pelvic mass

Question 2

What causes the majority of HMB?

Answer 2

Dysfunctional uterine bleeding. can be ovulatory/regular or anovulatory/irregular and is not associated with any underlying pathology

Question 3

What are the four most common pathological causes of HMB?

Answer 3

Fibroids, polyps, adenomyosis and endometriosis

Question 4

What are fibroids?

Answer 4

benign smooth muscle tumors of the uterus

Question 5

When and in which demographics do fibroids typically occur?

Answer 5

They typically occur in the later reproductive years in 20% of white women and 50% of black women

Question 6

What is used to definitively diagnose fibroids?

Answer 6

transvaginal ultrasound

Question 7

What is the first line treatment for fibroids?

Answer 7

Levonorgestrel releasing IUS

Question 8

Aside from the IUS what other treatments can be used to treat fibroids?

Answer 8

Transexamic acid and COCP. Myomectomy, hysterscopic endometrial ablation, hysterectomy or uterine artery embolization

Question 9

How are uterine polyps diagnosed

Answer 9

hysteroscopy following history taking

Question 10

What is the recommended treatment for uterine polyps

Answer 10

surgical excision, biopsy is taken after and may indicate the need for a hysterectomy