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Obs & Gynae > Abnormal vaginal bleeding > Flashcards

Abnormal vaginal bleeding Flashcards

1
Q

Causes of meorrhagia

A 
Polyp
Adenomyosis
Leiyomyoma 
Malignancy
Coagulopathy
Ovary dysfunction
Iatrogenic - IUD
Endometrial - hyperplasia, endometriosis 
Endocrine - hypothyroidism 
Not classified - DUB
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2
Q

Classification of abnormal vaginal bleeding

A 
Post menopausal
Intermenstrual
Post coital
Menorrhagia
Dysmenorrhea 
Oligomenorrhoea >35 days apart
Polymenorrhoea <21 days apart 
Pregnancy related (ectopic, missed/incomplete/threatened miscarriage, gestational trophoblastic disease)
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3
Q

Management of menorrhagia

A 
Conservative: regular paracetamol, hot water bottle 
Drugs: mefenamic acid, tranexamic acid 
Regulating menstrual cycle: 
1st line - IUS
2nd line - tranexamic acid, COCP
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4
Q

MoA of mefanamic acid

A

NSAID: COX inhibitor so reduces prostaglandin synthesis which reduced bleeding

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5
Q

MoA of tranexamic acid

A

Prevents breakdown of fibrin

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6
Q

Symptoms of cervical polyps

A

Menorrhagia
Post coital bleeding
Intermenstrual bleeding

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7
Q

Symptoms and signs of endometriosis

A 
Dysmenorrhea I.e cyclical pelvic pain 
Dyspareunia 
Menorrhagia and/or polymenorrhoea 
Infertility 
Pain on defecation 
Fixed retroverted uterus (adhesions)
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8
Q

Common causes of post coital bleeding

A

Chlamydia infection

Cervical ectropion

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9
Q

Investigation for abnormal vaginal bleeding

A 
Depends on symptoms and age:
Hb, Fe, ferritin 
TFTs
Clotting 
Pregnancy test  
TVUS (?pregnancy or ?endometrial Ca)
Speculum and pelvic examination 
Cervical smear 
Hysteroscopy 
Laparoscopy
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10
Q

Laparoscopic findings in endometriosis

A

Powder burn spots
Endometrioma (blood filled ovarian cyst)
Fixed retroverted uterus

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11
Q

Diagnosis of PCOS

A

2/3 of following criteria:
Oligomenorrhoea or anovulation
Excess androgen (clinical or blood test)
At least 12 follicles on ovaries on TVUS

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12
Q

Blood tests suggesting PCOS

A

High testosterone
Low SHBG (due to high circulating insulin)
High LH:FSH

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13
Q

Symptoms and signs of PCOS

A 
Anovulation
Oligomenorrhoea 
Unintentional weight gain 
Hirsutism
Acanthosis nigricans 
Enlarged ovaries on pelvic examination
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14
Q

Pathophysiology of PCOS

A

Chronic high LH due to high GnRH causes increased androgens
Androgens converted peripherally to oestrogen
Oestrogen maintains high LH by +ve feedback and suppresses FSH
Low FSH means follicles don’t mature so from cysts

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15
Q

Long term risks of PCOS

A

Endometrial cancer risk as unopposed oestrogen from anovulation (no corpus luteum to produce progesterone)
Type 2 diabetes
Recurrent miscarriage

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16
Q

Management of PCOS

A

Weight loss, may need metformin
COCP to regulate menstrual cycle
Cyproterone acetate to decrease androgens
Spironolactone or laser hair removal/electrolysis for hirsutism

Clomiphene citrate if trying to conceive

17
Q

Primary vs secondary dysmenorrhea and causes

A

Primary - within 6 months of menarche. Caused by increased prostaglandin production.

Secondary - several years after menarche. Causes include endometriosis, adenomyosis, fibroids, adhesions.

18
Q

Treatment of dysmenorrhea

A 
Analgesia
Hot water bottles
Mefanamic acid 
IUS/COCP/POP
Hysterectomy if don't want anymore children
19
Q

Risk factors for fibroids

A 
FH
Early menarche
Afro Caribbean
Obesity
Vit D deficiency
20
Q

Classification of fibroids

A

Based on site:
Intramural
Subserosal
Submucosal

21
Q

Symptoms and signs of fibroids

A 
Menorrhagia
Dysmenorrhea 
IM bleeding 
Urinary frequency
Constipation
Infertility
Abdo pain
Irregular enlarged uterus
22
Q

Management options for fibroids

A 
Analgesia e.g mefanamic acid
Tranexamic acid
IUS 
COCP
Surgical if want to be made infertile - ablation, total hysterectomy, myomectomy
23
Q

Management of PMS

A

Symptoms diary
Reduce alcohol, caffeine and quit smoking
Vitamin B6, D and Ca supplements
COCP

Obs & Gynae (37 decks)

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