W1 - Abnormal Uterine Bleeding Flashcards
what is a normal period
volume - 5-80ml
for <8days
every 28days
what are some red flags for abnormal bleeding
Persistent intermenstrual bleeding
>45yr treatment failure
PCB (Postcoital bleeding)
PMB (Postmenopausal bleeding)
Pelvic mass
Suspicious cervix
what are some causes of abnormal bleeding
PALM COIN
Polyp
Adenomyosis
Leiomyoma - fibroids
Malignancy
Coagulopathy
Ovulation dysfunction
Endometrial
Iatrogenic
Not yet classified
what are fibroids
Commonest tumour of the female genital tract
who gets fibroids
Afro-Caribbean
Nulliparous
are fibroids oestrogen dependent or independent
dependent
what are common symptoms of fibroids
Anaemia
Gynaecological - AUB, HMB, pelvic pain, dyspareunia, pelvic/abdominal mass
Obstetric - infertility, miscarriage, abdominal pain, preterm labour, malpresentation, postpartum haemorrhage
how do fibroids develop
grow until menopause
can outgrow blood supply - degeneration and acute pain
what are possible complications of fibroids
- Hyaline degeneration
- Red degeneration (necrobiosis) miscarriage due to infarction at mid-pregnancy
- Calcification (‘womb stone’)
- Sarcomatous (malignant)
- Infection (abscess)
- Torsion of pedunculated fibroids
when is conservative treatment indicated for fibroids
Requires fertility
Asymptomatic
Pregnant
Menopause approaching
Small fibroids
what medication can be given to manage fibroids
GnRH Analogue Shrinkage of fibroids - ~50%
Short lived
what are the minimally invasive permantent treatment for fibroids
Hysteroscopic surgery/resection of polyps
Laparoscopic ablation/myomectomy
Embolisation of uterine arteries
what are the invasive permantent treatment for fibroids
hysterectomy
what is endometrial hyperplasia
Endometrial hyperplasia is defined as a proliferation of glands of irregular size and shape with an increase in the glands/stroma ratio.
what are some risk factors for endometrial cancer
Obesity, Diabetes, Hypertension, unopposed estrogen, nulliparity, PCOS, Tamoxifen
what are the risk factors for endometrial hyperplasia developing into endometrial cancer
without atypia - 2%
atypical - 23%
what is the first line treatment for hyperplasia without atypia
LNG IUS - intrauterine progesterone
Continuous medroxyprogesterone 10-20mg/day or norethisterone 10-15mg/day, not cyclical
for minimum of 6months
6month surveillance
who is at high risk of endometrial cancer
- persistent inter menstrual or persistent irregular bleeding
- infrequent heavy bleeding who are obese
- polycystic ovary syndrome
- tamoxifen
- unsuccessful treatment for HMB
what is the risk of tamoxifen causing uterine abnormalities
breast cancer
10-40%
