Intermenstrual bleeding, postcoital bleeding and postmenopausal bleeding Flashcards
What is intermenstrual bleeding?
Uterine bleeding between periods.
What is the aetiology of intermenstrual bleeding?
Idiopathic, hormonal contraceptives, endometrial causes (polyp, cancer) cervical causes (ectropion, cervicitis, polyp, cancer) vaginal causes (atrophic vaginitis, cancer) bleeding disorders, STI.
What is the epidemiology of intermenstrual bleeding?
15% women
What is the history of intermenstrual bleeding?
Frequency, volume, duration of symptoms, time in cycle, hx of infections, contraception, smear hx.
What is the exam of intermenstrual bleeding?
Speculum: examine vaginal walls, cervix (friable, discharge, evidence of IUD in situ)
Vaginal: assess for massess, cervical excitation or uterine tenderness (infection)
What is the Ix of intermenstrual bleeding?
Bloods: FBC (anaemia), clotting.
USS: pelvis (endometrial pathology)
Microbiology HVS, endocervical/chlamydia swabs.
Other: pregnancy test, cervical smear, pipele biopsy if endomtrial anomlay detected on scan.
What is the management of intermenstrual bleeding?
Medical: change contraceptive.
Surgical: if endometriosis, hysteroscopy with endometrial resection. Polypectomy if needed.
What are the complications and prognosis of intermenstrual bleeding?
Depends on age and cause. 20-40yo risk of cancer low, increases with age.
What is postcoital bleeding?
Vaginal bleeding during or after intercourse outside normal menstrual bleed.
What is the aetiology of postcoital bleeding?
Idiopathic, cervical (CIN, cancer, polyps, infection) vaignal (trauma, infection, atrophy, cancer) endometrial (polyps, cancer). Pregnancy related (placenta praevia).
What is the epidemiology of postcoital bleeding?
Point prevalence between 1-9%.
What is the history of postcoital bleeding?
Elicit frequency, volume, smoking, previous smars, sex hx, vaignal discharge, symptoms of infection and partners.
What is the exam of postcoital bleeding?
Speculum: Note any atrophy, examine cervix for ulceration, ectropion, polyp, IUCD, discharge.
What is the Ix of postcoital bleeding?
Micro: HVS, endocervical/Chlamydial swabs.
Cervical smearL if no recent normal result.
OtherL consider USS pelvis/Pivelle biopsy if persistent PCB.
What is the management of postcoital bleeding?
Treat if infection
Coloposcopy: fi cervix appears abnormal on speculum or smear abnormality.
Hysteroscopy: if persistent PCB with normal smear/coloposcopy.
What are the complications and prognosis of postcoital bleeding?
nting with PCB have cervical cancer. Of those with cervical cancer 10% Present with PCB to begin with.
What is the postmenopausal bleeding?
PV bleeding 12mo after last period.
What is the aetiology of postmenopausal bleeding?
Endometrial: polyp, hyperplasia, cancer.
Vaginal: atrophy, cancer, polyp, caginitis, truama
Cervical: polyp, cancer.
Other: bleeding disorder, spontaneous ovarian activity
What is the epidemiology of postmenopausal bleeding?
10% PM women.
What is the history/ exam of postmenopausal bleeding?
General: anaemia if heavy.
1+ episodes of PV bleed.
Abdomen: assess for mass.
Speculum: assess vulva, vagina and cervix. Pipelle biopsy.
Vaginal: uterine size, movement, adenxal masses.
What is the Ix for postmenopausal bleeding?
Blood: FBC.
Radiology: Pelvic USS (thick endometrium is >4mm in postmenopause)
Tissue diagnosis: Pipelle biopsy, or hysteroscopy and biopsy.
What is the Mx of postmenopausal bleeding?
Depends on cause. If none found, reassure.
What are the complications/ prognosis of postmenopausal bleeding?
Depedns on cause. Complicaitons of investigation (hysteroscopy). Most patients have no further problems, 10% develop endometrial cancer.
