Heavy menstrual bleeding

Question 1

• Irregular bleeding
• Intermenstrual bleeding
• Postcoital bleeding

Likely differentials are?

Answer 1

1. Endometrial polyp
2. Cervical polyp

Question 2

1. Endometrial polyp
2. Cervical polyp

Presents with;

Answer 2

Irregular bleeding

Intermenstrual bleeding

Postcoital bleeding

Question 3

How will ‘coagulation disorders’ present in a clinical history?

Answer 3

1. Excessive bruising
2. Excessive postoperative bleedong
3. Family history of bleeding problems
4. History of post partum haemorrhage

Question 4

Most likely cause of unusual vaginal discharge is?

Answer 4

Pelvic inflammatory disease

Question 5

PC : Urinary symptoms, it is likely to be …

Answer 5

Pressure from fibroids

Question 6

Heavy bleeding with.. weight change, skin changes and fatigue

Answer 6

Thyroid disease

Question 7

Aietiology of heavy menstrual bleeding?

( GYNAE CAUSES )

Answer 7

1. Fibroids
2. Endometrial polyps
3. Endometrial or Cervical cancer
4. Pelvic inflammatory disease

Question 8

Aietiology of heavy bleeding - systemic causes

Answer 8

1. Coagulation disorders
2. Thyroid disease

Question 9

Aietiology of heavy bleeding - iatrogenic causes

Answer 9

1. Intrauterine contraceptive device
2. Drug therapy - WARFARIN

Question 10

Ix of Heavy mentrual bleeding - WHICH BLOOD TESTS?

Answer 10

1. FBC - to ascertain the need for iron therapy
2. Coagulation screen
3. Thyroid function tests

Question 11

Ix of Heavy bleeding

Answer 11

1. Pelvic ultrasound - to identify polyps or masses
2. Vaginal/Endocervical swab - for PID
3. Endometrial biopsy

Question 12

When should endometrial biopsy be performed?

Answer 12

1. In those aged > 45
2. Irregular or intermentrual bleeding
3. Drug therapy has failed

Question 13

Tx if do not require contraceptive

Answer 13

mefenamic acid 500 mg tds (particularly if there is dysmenorrhoea as well) or tranexamic acid 1 g tds.

Both are started on the first day of the period

Question 14

Requires contraception, options include

Answer 14

First line - intrauterine system (Mirena)

Second line - combined oral contraceptive pill

3rd line - long-acting progestogens (Depo - poreva)

Question 15

Tx for contraceptive seeking menorrhagia

Answer 15

intrauterine system (Mirena) should be considered first-line