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Women's Health > Heavy Menstrual Bleeding > Flashcards

Heavy Menstrual Bleeding Flashcards

1
Q

Average blood loss per menstrual cycle?

A

35mLs per cycle

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2
Q

Average length of menses?

A

3-7 d

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3
Q

What is menorrhagia?

A

Prolonged (7d+) or excessive (80mLs+ per cycle) occurring at regular intervals

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4
Q

What is metrorrhagia?

A

Irregular cycle and more frequent

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5
Q

What is menometrorrhagia?

A

Prolonged or excessive bleeding occurring at irregular and more frequent intervals

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6
Q

What is metros taxis?

A

Acute, very heavy bleed

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7
Q

Ddx of vaginal bleeding?

A
  • DUB
  • Systemic: endocrine, bleeding disorders, liver disease)
  • Adenomyosis
  • Fibroids
  • Polyps
  • Inection
  • Carcinoma
  • Iatrogenic
  • Pregnancy
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8
Q

What is DUB?

A

No organic pathology; diagnosis of exclusion. May be ovulatory or anovulatory.

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9
Q

What is ovulatory DUB?

A

Aetiology unclear. May be due to excessive prostacyclin production which increases vasodilation and decreases platelet aggregation.

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10
Q

What is pathophysiology of anovulatory DUB?

A

Normal: with ovulation CL makes progesterone
Anovulatory:
- no ovulation, CL does not develop.
- No progesterone produced.
- Unopposed oestrogen = endometrial thickening until outgrows blood supply - necrosis and shedding. Cycles therefore long and irregular. d

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11
Q

What are the RFx for anovulatory DUB?

A

Extremes of reproductive life
- Adolescence
- Perimenopause
But can occur at any stage

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12
Q

What are the consequences of anovulatory DUB?

A

May present with any menstrual pattern.

  • Fe deficiency anemia
  • Infertility
  • If chronic: inc RFx endometrial hyperplasia and cancer
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13
Q

Endocrine causes of anovulatory DUB?

A
  • Thyroid
  • Pituitary / adrenal disorders
  • PCOS
  • Significant weight changes
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14
Q

What are the uterine and local causes of DUB?

A
  • Myometrium: fibroids, adenomyosis
  • Endometrium: polyps, hyperplasia, carcima, endometritis, IUD
  • Cervix: polyps, Ca
  • Ovarian pathology
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15
Q

Proportion of women with fibroids?

A

20% of 30yo women

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16
Q

RFx for fibroids?

A
  • Nulliparity
  • Obesity
  • +ve FHx
17
Q

Symptoms of fibroids?

A

Mostly asymptomatic

  • Pressure
  • Frequency (urinary)
  • Menstrual disturbance
  • Pregnancy issues
  • Pain: if necrosis, torsion
18
Q

Mx fibroids?

A
  • Hormonal if symptomatic
  • Hysteroscopic resection if sub mucous
  • Myomectomy
  • Hysterectomy
  • Embolisation / ablation
19
Q

What is adenomyosis?

A

Endometrial glands within myometrium

20
Q

CFx of adenomyosis?

A
  • Multiparous; 30s/40s
  • Menorrhagia
  • Dysmenorrhoea
  • Bulky, tender uterus
21
Q

Ix of choice in adenomyosis diagnosis?

A

MRI

USS is insensitive

22
Q

Mx adenomyosis?

A
  • Induce amenorrhoea with hormonal treatment
  • GnRH analogues
  • Mirena
  • Hysterectomy
23
Q

Presentation of endometrial carcinoma?

A
  • PMB
  • Menorrhagia
  • IMB
24
Q

RFx endometrial carcinoma?

A
  • Chronic anovulatory cycles
  • Unopposed oestrogen therapy
  • Obesity
  • PCOS
  • Nulliparous
  • Endometrial hyperplasia
  • FHx HNPCC
  • Tamoxifen
25
Q

How is endometrial cancer diagnosed?

A

Endometrial sampling

26
Q

Iatrogenic causes of DUB?

A
  • OCP
  • Depot provera
  • Implanon
  • IUD
  • Anticoagulation
  • Chemotherapy (thrombocytopenia)
27
Q

Bimanual exam features of adenomyosis?

A

Large, tender, globular uterus

28
Q

What is first line endometrial sampling?

A

Pipette first line.

  • OPD; no anaesthetic
  • Normal does not exclude problem
29
Q

What should be done in pipelle endometrial sampling shows malignancy?

A

If malignancy: refer straight to oncology - no Hysteroscopy D&C

30
Q

Gold standard endometrial sampling to exclude carcinoma or hyperplsia?

A

Hysteroscopy D & C

31
Q

Risks of Hysteroscopy D&C?

A
  • Uterine perforation
  • Infection
  • Gas embolism
32
Q

Work up for PMB?

A
  • TV USS and pipelle
  • If both normal (ET under 4mm) can observe
  • If recurs, or any abnormality: HD&C
33
Q

Medical Mx of HMB?

A
  • Treat cause
  • A. Non Hormonal: PG inhibitors, anti-fibrinolytics
  • B. Hormonal: OCP, depot provera, GnRH analogues
  • C. Procedural: Mirena
34
Q

Surgical Mx of HMB indication?

A

If medical treatment fails and fertility not desired

35
Q

Surgical Mx of HMB?

A
  • Endometrial ablation

- Hysterectomy

36
Q

Commonest cause of teenagers with HMB?

A

Anovulatory DUB (80% ovulatory 3y after menarche)

37
Q

metrostaxis Mx?

A
  • ABCs; resuscitate
  • Tranexamic acid first line
  • High dose progesterone acutely
38
Q

Hx to elicit when evlaluating HMB?

A
  • Age
  • Parity
  • LNMP and ?preg
  • frequency / vol / pattern
  • Impact on QoL
  • Comorbidities (diabetes, obesity, PCOS, thyroid disease, bleeding disorders)
  • Pelvic pain or pressure
  • Fhx: endometriosis, endometrial or bowel cancer

Women's Health (39 decks)

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