OnG

Question 1

What are the causes of menorrhagia?

Answer 1

Structural:
Polyp
Adenomyosis
Leimyoma
Malignant change

Non structural causes:
Coagulopathy
Ovarian dysfunction
Endometrial - endometritis PID
Iatrogenic - intrauterine evices, systemic agents, anticoagulants.

Question 2

When shouyld you refer a woman with HMB

Answer 2

Anyone with recurrent IMB

anyone with new onset IMB over 40

anyone with treatment failure.

Anyone you suspect to have a malignancy on the 2WW

Any vulval bleeding or ulcerations

Question 3

What is the treatment pathway for menorhagia?

Answer 3

not trying for baby:
IUS
tranexamic acid/COCP
long acting progestogens

Wants baby:
tranexamic acid - cyclo F
mefanamic acid - better for pain

Surgical:
myomectomy
endometrial ablation
hysterectomy

Question 4

What do you do when a woman will not stop bleeding.

Answer 4

give oral norethisterone 5mg once daily for 10 days.

Question 5

What are the causes of irregular menstruation and IMB?

Answer 5

Annovulatory cycles are the most common and are more prevalent in early and late reproductive years

Pelvic pathology:
cervical polyp.
(most causes of menorhagia)

Question 6

What are the main causes of PCB?

Answer 6

ectropian - cryo
cervical polyp - avulse
cancer - smear and refer

Question 7

What is the management of PID

Answer 7

swab and urine
remove IUS/D
ofloxacin +met
OR
cef stat and dox and met

Question 8

What does HRT prevent in women with POF

Answer 8

osteoporosis
dementia
heart disease