Gynae - Bleeding disorders in non pregnant women

Question 1

Name three bleeding disorders in non-pregnant women

Answer 1

Menorrhagia - heavy or prolonged periods
Intermenstrual bleeding
Post coital bleeding

Question 2

Aetiology or causes of menorrhagia

Answer 2

Dysfunctional uterine bleeding
Fibroids
Adenomyosis
Copper IUCD
Bleeding disorders 
Thyroid disorders

Question 3

What is the management for DUB?

Answer 3

Hx & Examination
FBC
Pelvic ultrasound
Hysteroscopy & biopsy (in >45 years)

Question 4

What are the management methods for DUB?

Answer 4

Conservative - do nothing & prescribe ferrous sulphate

Medical management: Tranexamic acid, COCP, POP, Depo injections, Implanon, Mirena IUS

Surgical management:
Endometrial ablation
Hysterectomy

Question 5

What are the causes of intermenstrual bleeding?

Answer 5

Anovulation
Endometrial polyps
Copper coil
Progesterone only contraceptives 
Endometrial cancer

Question 6

What are the investigations for polyps?

Answer 6

Transvaginal US

Hysteroscopy & biopsy in >45 years old women

Question 7

What are the management methods for intermenstrual bleeding?

Answer 7

Hormonal treatment
Removal of polyps
If cancer, treatment via the MDT

Question 8

What are the causes of post coital bleeding

Answer 8

Cervical polyps
Cervical ectropion
Infection (chlamydia)
Cervical cancer

Question 9

What investigations should be carried out in post coital bleeding?

Answer 9

Speculum examination
Cervical swabs
Colposcopy +/- biopsy

Question 10

What are the management methods for post coital bleeding

Answer 10

Antibiotics
Removal of polyps
Cervical cautery
Treatment of cervical cancers as per MDT