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3. Y5 Zero to finals: O&G > Heavy Menstrual Bleeding > Flashcards

Heavy Menstrual Bleeding Flashcards

1
Q

What is Heavy Menstrual Bleeding?

A

Excessive menstrual loss which interferes with a woman’s quality of life

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2
Q

What percentage of women experience Heavy Menstrual Bleeding?

A

3%

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3
Q

What age group of women are most affected by Heavy Menstrual Bleeding?

A

40-51 years old

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4
Q

What is the mnemonic used to divide the different causes of Heavy Menstrual Bleeding?

A

Palm-Coein

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5
Q

What does the PALM bit of the Palm-Coein mnemonic mean?

A

Structural causes of Heavy Menstrual Bleeding:

P – Polyp

A – Adenomyosis

L – Leiomyoma (Fibroid)

M – Malignancy / hyperplasia

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6
Q

What does the COEIN bit of the Palm-Coein mnemonic mean?

A

Non-structural causes of Heavy Menstrual Bleeding:

C – Coagulopathy

O – Ovulatory dysfunction

E – Endometrial

I – Iatrogenic

N – Not yet classified

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7
Q

What are the main risk factors for Heavy Menstrual Bleeding? (2 things)

A
  1. Age
  2. Obesity
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8
Q

What are the CF of Heavy Menstrual Bleeding? (3 things)

A
  1. Bleeding
  2. Fatigue
  3. SOB (if associated anaemia)
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9
Q

What are you looking for @ examination of Heavy Menstrual Bleeding patient? (4 things)

A
  1. Pallor (anaemia)
  2. Palpable uterus / pelvic mass
  3. Inflamed cervix / cervical polyp / tumour
  4. Vaginal tumour
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10
Q

What are you suspecting if a Heavy Menstrual Bleeding patient has an irregular uterus @ examination?

A

Fibroids

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11
Q

What are you suspecting if a Heavy Menstrual Bleeding patient has a tender uterus / cervical excitation @ examination? (2 things)

A
  1. Adenomyosis
  2. Endometriosis
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12
Q

What are the differential diagnoses for Heavy Menstrual Bleeding? (9 things)

A
  1. Pregnancy
  2. Endometrial / cervical polyps
  3. Adenomyosis
  4. Fibroids
  5. Malignancy / endometrial hyperplasia
  6. Coagulopathy
  7. Ovarian dysfunction
  8. Iatrogenic causes
  9. Endometriosis
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13
Q

What are the CF of Endometrial / cervical polyps? (3 things)

A
  1. Intermenstrual bleeding
  2. Post-coital bleeding
  3. NOT associated w dysmenorrhea (painful periods)
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14
Q

What are the CF of Adenomyosis? (2 things)

A
  1. Dysmenorrhea
  2. Bulky uterus (@ exam)
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15
Q

What are the CF of Fibroids? (2 things)

A
  1. Hx of pressure symptoms (e.g urinary frequency)
  2. Bulky uterus (@ exam)
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16
Q

What is the most common Coagulopathy to cause Heavy Menstrual Bleeding?

A

Von Willebrand’s disease

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17
Q

What are the CF of Von Willebrand’s disease? (5 things)

A
  1. HMB since menarche
  2. PPH Hx
  3. Surgical / dental related bleeding (bleeding gums)
  4. Easy bruising / epistaxis
  5. Bleeding disorder FHx
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18
Q

What should you consider for pt w Von Willebrand’s disease?

A

Warfarin (anti-coagulant)

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19
Q

What are the most common causes of Ovarian dysfunction? (2 things)

A
  1. PCOS
  2. Hypothyroidism
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20
Q

What are the iatrogenic causes of HMB? (2 things)

A
  1. Contraceptive hormones
  2. Copper IUD
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21
Q

What percentage of all HMB does Endometriosis represent?

A

Less than 5%

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22
Q

What investigations should you do for HMB? (5 things)

A
  1. Urine pregnancy test
  2. FBC
  3. TFT
  4. Hormone tests (e.g if sus PCOS)
  5. Coag screen (+ check for Von Willebrand’s) if sus
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23
Q

Why should you do a FBC for HMB?

A

Anaemia presents after 120ml menstrual blood loss

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24
Q

When should you do a TFT for HMB?

A

If has other signs of hypothyroidism

25
Q

What imaging should you do for HMB?

A

Transvaginal US

26
Q

What is a Transvaginal US useful for?

A

Checking endometrium / ovaries

27
Q

When should you for a Transvaginal US in HMB? (2 things)

A
  1. Uterus / pelvic mass palpable @ exam
  2. Pharmacological tx failed
28
Q

When should you do a Cervical smear in HMB?

A

If hasn’t had routine ones done

29
Q

What investigation should you for HMB if sus infection?

A

High vaginal / endocervical swabs

30
Q

What biopsy can be done for HMB?

A

Pipelle endometrial biopsy

31
Q

When should you do a Pipelle endometrial biopsy in HMB? (3 things)

A
  1. Persistent intermenstrual bleeding
  2. 45+ age
  3. Pharmacological tx failed
32
Q

When should you do a Hysteroscopy / Endometrial biopsy for HMB?

A

US identifies pathology / is inconclusive

33
Q

What is the aim of management of HMB?

A

Improve woman’s quality of life (rather than specific reduction in blood loss volume)

34
Q

When considering HMB management options, what should you discuss with the patient?

A

Impact on fertility

35
Q

What is the management approach for HMB when there is no sus pathology?

A

3 tiered approach

36
Q

What is the 3 tiered approach for HMB?

A
  1. Levonorgestral-releasing intrauterine system (LNG-IUS)
  2. Tranexamic acid / Mefanamic acid / COCP
  3. Progesterone only: Oral Norethisterone / Depo / Implant
37
Q

What does Levonorgestral-releasing intrauterine system (LNG-IUS) also act as?

A

Contraceptive

38
Q

How long is Levonorgestral-releasing intrauterine system (LNG-IUS) licenced for treatment?

A

5 years

39
Q

How does Levonorgestral-releasing intrauterine system (LNG-IUS) work? (2 things)

A
  1. Thins endometrium
  2. Shrinks fibroids
40
Q

What does the woman’s choice to use Tranexamic acid / Mefanamic acid / COCP depend on?

A

Her wishes for fertility

41
Q

When should Tranexamic acid be used?

A

Only during menses to reduce bleeding

42
Q

Does Tranexamic acid have an effect on fertility?

A

No

43
Q

What is a pro for using Mefanamic acid?

A

Is an NSAID = offers analgesia for dysmenorrhoea

44
Q

When should Mefanamic acid be used?

A

Only during menses to reduce bleeding

45
Q

Does Mefanamic acid have an effect on fertility?

A

No

46
Q

Does Oral Norethisterone work as a contraceptive?

A

No

47
Q

Do Depo / Implant progesterone work as a contraceptive?

A

Yes

48
Q

What are the main Surgical management options for HMB? (2 things)

A
  1. Endometrial ablation
  2. Hysterectomy
49
Q

What are some other Surgical management options only for HMB caused by fibroids? (2 things)

A
  1. Myomectomy
  2. Uterine artery embolization
50
Q

What is Endometrial ablation?

A

Lining of uterus obliterated

51
Q

Who is Endometrial ablation suitable for?

A

Women who no longer wish to conceive

52
Q

By how much does Endometrial ablation reduce HMB?

A

Up to 80%

53
Q

Where can Endometrial ablation be performed?

A

Outpatient using local anaesthetic

54
Q

What is the only definitive treatment for HMB?

A

Hysterectomy

55
Q

What does Hysterectomy offer? (2 things)

A
  1. Amenorrhoea
  2. End to fertility
56
Q

What are the types of Hysterectomy performed? (2 things)

A
  1. Subtotal (partial)
  2. Total
57
Q

What is Subtotal (partial) Hysterectomy?

A

Removal of uterus but NOT cervix

58
Q

What is Total Hysterectomy?

A

Removal of uterus and cervix

59
Q

What openings can Hysterectomy be performed via? (2 things)

A
  1. Abdominal incision
  2. Vagina

3. Y5 Zero to finals: O&G (27 decks)

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