Menstrual disorders

Question 1

What does AUB stand for? What is its definition?

Answer 1

Abnormal uterine bleeding

Any menstrual bleeding that is either:
- abnormal in volume (excessive duration or heavy)

• abnormal regularity/timing (delayed or frequent)
• non-menstrual (IMB, PCB or PMB).

Question 2

What does HMB stand for and what is its definition?

Answer 2

Heavy menstrual bleeding

menstrual blood loss that is considered to be excessive by the woman and interferes with her physical, emotional, social and material quality of life.

It can occur alone or in combination with other symptoms

Question 3

What questions should you ask a woman who presents with heavy menstrual bleeding?

Answer 3

Heaviness
Clots
Flooding

Type of pad
Frequency of pad change
Waking at night to change

IMPACT ON DAILY LIFE

Any other symptoms, pain/pressure (incl anaemia)

Up to date with smear tests?

Gynae Hx

Obstetric Hx

Medical Hx - bleeding disorders, drugs, social and family history

Question 4

How should you examine someone who presents with menstrual problems?

Answer 4

General examination
Abdominal examination
Pelvic examination

Question 5

What investigations should you do if someone presents with heavy bleeding?

Answer 5

FBC
TFTs
Clotting studies (if indicated)
USS (if uterus feels irregular)
Hysteroscopy, biopsy

Question 6

When would you use US to investigate heavy bleeding?

Answer 6

If uterus feels irregular

Question 7

What are the management options for someone with heavy bleeding?

Answer 7

Rule out serious causes - most likely to be dysfunctional uterine bleeding

Medication: Mefenamic acid/tranexamic acid
Mirena IUS

Endometrial ablation
Hysterectomy

Question 8

What are differential diagnoses for IMB and PCB without symptoms?

Answer 8

Cervical: polyp, cervicitis, ectropion, cancer

Endometrial: polyp, submucosal fibroid

Question 9

How would you investigate a woman with IMB and PCB?

Answer 9

Smear test

Pipette (unless referring for hysteroscopy)

US

Hysteroscopy

Question 10

What is the management for a woman who presents with IMB, PCB and has cervical pathology/abnormal smear?

Answer 10

Colposcopy

Question 11

What is the management for a woman who presents with IMB, PCB and has cervical/endometrial fibroid?

Answer 11

Resection

Question 12

What is the management for a woman who presents with IMB, PCB and has cervical ectropion?

Answer 12

AgNO3

Question 13

What is the management for a woman who presents with IMB and PCB, but investigations find NAD?

Answer 13

Reassure

safety net

Question 14

What are some causes of post-menopausal bleeding?

Answer 14

Endometrial pathology

Vaginal atrophy

Cervical pathology

Question 15

How would you examine a woman with post-menopausal bleeding?

Answer 15

Abdominal and pelvic examination

Question 16

How would you investigate a woman with post-menopausal bleeding?

Answer 16

FAST TRACK - COULD BE CANCER

Urgent US
Urgent hysteroscopy and biopsy

Question 17

How would you manage a woman with endometrial hyperplasia?

Answer 17

Progestogens/hysterectomy

Question 18

How would you manage a woman with endometrial cancer?

Answer 18

Refer to gynae oncology

Question 19

How would you manage a woman with vaginal atrophy?

Answer 19

reassure

lubricants

E2 creams

Question 20

For menstrual disorders, how long after commencing treatment would you follow patient up?

Answer 20

3 months (if not malignant or pre-malignant)

Question 21

What is the first line option for women with menstrual problems, a normal uterine cavity, an no short-term desire for fertility?

Answer 21

Mireia coil

Question 22

What is the first line treatment you should offer to women with HMB which is not complicated by large fibroids?

Answer 22

Second generation endometrial ablation