Menstrual irregularity

Question 1

What is IMB?

Answer 1

Intermenstrual bleeding is bleeding that occurs outside of the expected window of menstruation

Question 2

What are the common causes of IMB?

Answer 2

Midcycle fall in oestrogen production
Cervical polyps
Ectropion
Carcinoma
Cervicitis/vaginitis
Hormonal contraception (spotting)
IUCD
Chlamydia
Pregnancy related

Question 3

What may cause uterine IMB?

Answer 3

Pills
Endometritis
Polyps
Cancer

Question 4

How might the ovaries cause IMB?

Answer 4

Ovulation

Tumours

Question 5

How might the cervix cause IMB?

Answer 5

Infection
Ectropion
Iatrogenic
Cancer

Question 6

How might the vagina cause IMB?

Answer 6

Vulvovaginitis
Trauma
Cancer

Question 7

What Ix would be indicated in IMB?

Answer 7

FBC - Hb
Exclude malignancy (e.g. smear, cancer markers)
USS if >35y (+endometrial biopsy if thickening found)

Question 8

How is IMB managed?

Answer 8

Drugs
-IUS/COCP if no anatomical cause detected
-Progestogens
-Reassurance 
Surgery
-Hysteroscopy +/- polypectomy

Question 9

What is PCB?

Answer 9

Post coital bleeding is vaginal bleeding following intercourse that is not menstrual loss (exception for first intercourse)

Question 10

What causes PCB?

Answer 10

Cervical trauma
Polyps
Cervical, endometrial, vaginal carcinoma
Cervicitis or vaginitis (atrophic normally) of any cause
Infective e.g. chlamydia
Ectropion (esp in teenagers, pregnancy, COCP users)

Question 11

How is PCB managed?

Answer 11

Inspect cervix and take smear

Refer if bleeding persistent

Question 12

What is the incidence of cervical cancer in patients with PCB?

Answer 12

1 in 2400 aged 45-54

1 in 44,000 aged 20-24