Gynaecological Problems 2 Flashcards
What are some of causes of intermenstrual bleeding?
Pregnancy related (ectopic/GTD)
Physiological (spotting around ovulation)
Vaginal - vaginitis, tumours, adenosine
Cervical - STI, cancer, polyps, ectropion
Uterine - fibroids, polyps, cancer, adenomosis, endometriosis
Oestrogen-secreting ovarian cancers
Iatrogenic - tamoxifen, after a smear/treatment to cervix, missing OCP, drugs affecting clotting
What investigations should be used for intermenstrual bleeding?
pregnancy test infection screen - chlamydia cervical smear only if due FBC, clotting, TFT transvaginal US to look for abnormality
How would you manage inter menstrual bleeding if you suspected cancer?
full pelvic examination
incl cervical speculum examination and refer
How would you manage inter menstrual bleeding if you suspected infection?
abx depends on organism involved and contact tracing
How you you manage inter menstrual bleeding when hormonal contraception is used?
unscheduled bleeding in first 3 months after starting a new hormonal contraceptive method
speculum +/- bimanual examination if beyond 3 months, no change in symptoms
reassurance/medical treatment if findings normal, no other symptoms + woman >45
If beyond 6 months or no contraceptive use then US
What is cervical ectropian?
glandular/columnar cells from the ‘inside’ of the cervical canal are present on the ‘outside’ of the vaginal portion of the cervix which contains squamous cells
How is inter menstrual bleeding due to cervical ectropion treated?
may resolve spontaneously if COCP is stopped or after pregnancy
can be managed conservatively or cauterised with silver nitrate therapy
How is intermenstrual bleeding due to polyps treated?
avulse and send for histology
How are fibroids treated when causinng inter menstrual bleeding?
small fibroids are removed hysteroscopically
uterine artery embolism
drugs that reduce oestrogen levels
larger fibroids can be treated with drugs
What is post coital bleeding?
vaginal bleeding after intercourse that is not menstrual loss (must exclude cervical carcinoma unless first intercourse)
What are the causes of post coital bleeding?
cervical carcinoma
cervical ectropion
cervical polyps
cervicitis/vaginitis
What are the basic investigations for post coital bleeding?
inspect cervix and smear
if polyps evident - avulse and send for histology
if smear normal treat ectropion with cryotherapy
if not coloscopy to exclude malignancy
What are the causes of menstrual irregularity?
Anovulatory cycles common just after menarche or before menopause Fibroids Uterine + cervical polyps Adenomyosis Ovarian cysts Chronic pelvic infection Ovarian/cervical malignancy
How should menstrual irregularity be investigated?
haemoglobin
cervical smear
US exam of cavity (if >35 years)
endometrial biopsy (if thickened, in >40s)
How is menstrual irregularity managed if no anatomical cause?
IUS or COCP - regular and lighter menstruation
Progesterones - amenorrhoea but bleeding following withdrawal
