Uterine Bleeding

Question 1

Why are endometrial biopsys difficult to interpret?

Answer 1

constant physiological changes
hormone therapy - must know if they are on hormone therapy before looking at a biopsy
lack of clinical data

Question 2

What defines post menopausal bleeding?

Answer 2

abnormal bleeding > 1 year after last period

Question 3

What can cause abnormal bleeding in early life?

Answer 3

anovulatory cycles
pregnancy/miscarriage
endometritis
bleeding disorder

Question 4

What can cause abnormal bleeding in reproductive life?

Answer 4

pregnancy/miscarriage
Disordered uterine bleeding - DUB
endometritis
endometrial/endocervical polyp 
leiomyoma - smooth muscle tumour
adenomyosis - glands and stroma in the myometrium
hyperplasia
neoplasia
bleeding disorders
exogenous hormone affects

Question 5

What can cause post menopausal bleeding in reproductive life?

Answer 5

exogenous hormones - HRT, tamoxifen 
atrophy
endometrial polyp 
bleeding disorders
hyperplasia, endometrial carcinoma, sarcoma

Question 6

What are the 4 ways of assessing the endometrium?

Answer 6

transvaginal ultrasoun
hysteroscopy
endometrial pipelle
dilation and curretage

Question 7

What endometrial thickness indicates a need for biopsy?

Answer 7

16mm in pre menopausal

>4mm in post menopaual

Question 8

What is the most common and thorough sampling method?

Answer 8

dilaton and curretage

Question 9

What is Dysfunctional uterine bleeding (DUB)?

Answer 9

diagnosis of exclusion
irregular uterine beeding that reflects a distruption in the normal cyclic pattern of ovulatory hormonal stimulation to the endometrial lining
there is no organic cause

Question 10

How does DUB usually present?

Answer 10

obese women

end of reproductive life - due to disordered proliferation

Question 11

How is DUB investigated?

Answer 11

1st line - pipelle biopsy
then hysteroscopic directed or dilatation and curretage
transvaginal ultrasound - measures endometrial thickness, polyps etc
do cervical smear and coagulation screen etc too

Question 12

What is the non surgical management of DUB?

Answer 12

progesterone (mirena) or combined pill
GnRH analogues
NSAIDs
anti fibrinlytics 
capillary wall stabalisers

Question 13

What is the surgical management of DUB?

Answer 13

fertility is lost with these options
endometrial ablation/resection - fewer complications
hysterectomy - no cervical smears required

Question 14

What are some organic causes of abnormal uterine bleeding?

Answer 14

endometritis
polyp
miscarriage
adenomyosis 
leimyoma - growth is oestrogen dependant

Question 15

What is endometritis?

Answer 15

abnormal pattern of inflammatory cells in the endometrium

ie inflammed endometrium usually due to infection

Question 16

What pathogens commonly cause endometritis?

Answer 16

neisseria
chlamidya
TB
CMV
actinomyces - fungi associated with IUD
HSV

Question 17

What non infectious agents can cause endometritis?

Answer 17

IUD
post partum
post abortal 
post curettage
chronic endometiris 
granulomatous 
polyps
leiomyoma

Question 18

What is chronic plasmacytic endometritis?

Answer 18

plasma cells in the endometrium - infectious until proven otherwise

Question 19

What is a molar pregnancy?

Answer 19

non viable pregnancy where a non viable fertilised egg implants into the uterus or tube
characterised by swollen villi

Question 20

What are the two types of molar pregnancies?

Answer 20

complete mole - only has fathers DNA, either caused by 1 or 2 sperm, normally just the one
partial mole - 2 lots of fathers DNA, one lot of mothers DNA

Question 21

What type of mole has a higher chance of progressing to a choriocarcinoma?

Answer 21

complete mole

Question 22

What is used to stop a complete mole becoming a choriocarcinoma?

Answer 22

HCG

Question 23

What is a choriocarcinoma?

Answer 23

malignant tumour of trophoblasts