Vaginal bleeding in non-pregnant Flashcards
What are the types of causes of bleeding PV?
Uterine bleeding
Cervical bleeding
Vaginal bleeding
Vulvar bleeding
What are some causes of uterine bleeding?
Menstruation PCOS Endocrine causes Polyps, Fibroid, cysts Endometriosis Adenomyosis Malignancy Drugs
What is menorrhagia?
Excessive menstrual blod flow >80mls
Deemed excessive by the woman
What are the causes of menorrhagia?
Dysfunctional uterine bleedung Anovulation Fibroids Hypothyroidism Copper coil PID Bleeding disorders
What is anovulation?
Ovaries don’t release ovum during menstrual cycle
Who is anovulation commonly seen in?
Adolescents
Premenopausal women
What are the features of anovulation?
Non cyclical bleeding of variable flow and duration
Monoliminal symptoms usually absent
What is the risk with anovulation?
Increased risk endometrial hyperplasia and cancer
What are the endocrine causes of abnormal menstrual bleeding?
Pathology- thyroid, Cushing’s
Strenuous exercise
Sudden weight change
Significant stress
What are polyps?
Benign endometrial growths
Common in pre and post menopausal women
What are the features of polyps?
Asymptomatic IMB > menorrhagia -Irregular bleeding, Bleeding after straining/heavy lifting, PMB -Breakthrough bleeding Normal uterus on exam
What are fibroids?
Smooth muscle growths
What are the types of fibroids?
Submucosal
Intramural
Subserosal
What are the features of fibroids?
Asymptomatic
Menorrhagia > IMB
Pressure symptoms
Large/asymmetric uterus
What is adenomyosis?
Endometrial glands and stroma present in uterine muscle
What are the features and mx of adenomyosis?
Diffusely enlarged and tender uterus
Heavy prolonged, painful periods
GnRH agonists, hysterectomy
What are the symptoms of chronic endometriosis?
Heavy prolonged periods PCB, IMB Spotting Crampy lower abdo and back pain- starts several days before period Uterine tenderness Dyschezia, dysuria, deep dyspareunia
What is acute endometriosis?
Postpartum endometriosis with recent complications of pregnancy
What are the features of acute endometriosis?
Fever
Uterine tenderness
Foul vaginal discharge
Leukocytosis
What is post menopausal bleeding a red flat for?
Endometrial cancer
What drugs can cause abnormal PV bleeding?
Contraception
Chemotherapy induced thrombocytopenia
Antipsychotics
What are the features of a ruptured ovarian cyst?
Pain
Light uterine bleeding
What other organ diseases can cause abnormal PV bleeding?
Liver
Renal
Pituitary/hypothalamic
Thyroid
What is the typical presentation of cervical bleeding?
Sporadic spotting, commonly post coitally
What are the features of cervical cancer?
Sporadic and post coital bleeding
Watery, mucoid, purulent malodorous discharge
What are causes of cervical bleeding?
Cervical cancer Cervicitis Polyps Ectropion Endometriosis Vasculitis
What are the features of cervicitis?
Post coital bleeding
Strawberry red cervix that bleeds on contact
What are the features of cervical polyps?
Post coital and sporadic bleeding
Polyps can be visualised on speculum
What is ectropion?
Endocervical glandular tissue on cervix
What are the features of ectropion?
Post coital bleeding
Large transition zone on speculum exam
Bleeding on contact
What is the typical presentation pf vaginal bleeding?
Sporadic and post coital bleeding
What causes vaginal bleeding?
Vaginitis Ulcers Malignancy Radiation Trauma
Who is vaginal cancer seen in?
Most commonly post menopausal but can be in children
What are the features of vaginal cancer?
PMB
PCB
Watery, blood tinged malodorous discharge
Vaginal mass
What are the causes of vulvar bleeding?
Infection
Benign lesions
Malignancy
Trauma
How do you treat cervical ectropion?
Diathermy
Cryotherapy
Silver nitrate
