Intermenstrual bleeding/Post coital bleeding Flashcards

1
Q

Intermenstrual bleeding/Post coital bleeding:

Approach?

A
1)	
Exclude:
a)	Pregnancy
b)	STI 
c)	Cervical cancer

2)
Investigate:
a) 1st Episode = conservative management
*if bleeding continues = TV USS (with Endometrial thickness (ET))
b) Anovulatory or PCOS = TV USS (with ET)

3)
USS result
-any result other than below is managed conservatively

  • > 12mm premenopausal = Referral (seen within 6 weeks)
  • > 5mm perimenopausal = Referral (seen within 6 weeks)
  • Focal lesion = Referral (seen within 6 weeks)
  • excess fibrinolytic activity 50%
  • fibroids 30%
  • Polyps 10%
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2
Q

Intermenstrual bleeding/Post coital bleeding:

Timing of USS?

A

TUV within 5 - 10 days of bleeding

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3
Q

Intermenstrual bleeding/Post coital bleeding:

non hormonal options?

A

Non hormonal (equivalent to each other)

1) Prostaglandin inhibitors (20 – 49% effective)
• Ibuprofen 400mg TDS – QID for 5 days
• Mefenamic acid 500mg TDS for 5 days
• Naproxen 500mg then 250mg TDS – QID for 5 days

2) Antifibrinolytics (29 – 58% effective)
• Tranexamic acid 1- 1.5g TDS – QID for 4 -5 days
There is no risk of thrombosis as previously thought

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4
Q

Intermenstrual bleeding/Post coital bleeding:

hormonal options?

A

Hormonal (Superior control)
• LNG IUD 52mg (71 – 94% effective)

• Any COCP (43% effective)

  • Qlaira (Oestradiol) $$
  • Zoely (Oestradiol) $$
  • Valette (Dionogest) $$
  • Northisterone 15mg/d 5 – 26 days (83% effective) for max 6 months
  • Depot provera

*If no improvement after trying 2 methods in 6 months then refer

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5
Q

Intermenstrual bleeding/Post coital bleeding:

How to categorise causes?

A
PRIMARY
•	normal periods but abnormal haemostasis (50%)
ANATOMICAL = on USS
•	Fibroids 30%
•	Polyps 10%
ANOVULATORY
•	PCOS
•	Perimenopausal
OR
Structural causes (PALM) 
P – Polyps 
A – Adenomyosis 
L – Leiomyoma (fibroids) 
M– Malignancy or hyperplasia 
Non-structural causes (COEIN) 
C – Coagulopathy 
O – Ovulatory 
E – Endometrial 
I – Iatrogenic 
N – Not yet classified
OR
Think about anatomy and requirements:
Ovarian - ovulatory/hormonal
Blood supply - coagulation deficiency/malformation
Uterine
a) Myometrium - neoplasia, fibroids, polyps, adenomyosis
b) Endometrium - neoplasia, hyperplasia
c) Cervical - neoplasia, trauma, atrophy
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