Abnormal uterine bleeding

Question 1

What constitutes abnormal uterine bleeding?

Answer 1

• Bleeding between periods
• Bleeding after intercourse
• Heavy bleeding
• Menstrual cycle <24 days or >38 days
• Cycle length varying by more than 7-9 days
• Post-menopausal bleeding

Question 2

What constitutes heavy bleeding?

Answer 2

Blood loss of over 60ml during menstruation (however treatment is based on patient experience)

Question 3

What should you ask about when taking a history for heavy bleeding?

Answer 3

• Use of double protection
• Changing at night
• Flooding and leaking
• Large blood clots
• Symptoms of anaemia

Question 4

What causes heavy bleeding?

Answer 4

• Fibroids
• IUD
• Endometriosis
• PID
• Clotting disorders
• Polyps
• Hypothyroidism
• Anticoagulant medication
• Uterine cancer
• Impact on work

Question 5

How can heavy bleeding be managed?

Answer 5

• Mirena coil (also acts as contraceptive)
• Tranexamic acid or NSAIDS
• GnRH analogue
• Fibroid removal
• Endometrial ablation (SE of sterilisation)
• Hysterectomy (SE of sterilisation)

Question 6

What is secondary amenorrhoea?

Answer 6

When periods stop for 6 months or more

Question 7

What can cause irregular menstrual/intermenstrual bleeding?

Answer 7

Cervical polyps, fibroids, cysts and chronic PID.

In older women, likelihood of malignancy is slightly raised

Question 8

What causes dysmenorrhoea?

Answer 8

High levels of prostaglandin in the endometrium, often due to pelvic pathology, fibroids, endometriosis, PID.