Abnormal uterine bleeding Flashcards
What is the acronym for causes of abnormal uterine bleeding?
PALM COIEN
What does the acronym PALM COEIN stand for?
STRUCTURAL CAUSES Polyps Adenomyosis Leiomyomas Malignancy
NON-STRUCTURAL CAUSES Coagulopathy Ovulatory disorders Endometrial disorders Iatrogenic causes Not yet classified (rare)
What are the most important risk factors for endometrial polpys?
Tamoxifen
HRT
Describe the types of endometrial fibroid and how they might present?
Intramural: heavy bleeding
Subserous: compression symptoms
Submucosal: variable bleeding
What are the risk factors for fibroids?
Early menarche
African American ethnicity
What drug should be administered prior to surgical removal of fibroids?
GnRH analogues to reduce fibroid size
What are the first and second line treatments for menorrhage?
First line: Mirena IUS
Second line: TXA, mefenamic acid and COCP
How might ectropion present and why?
PCB - friable cervix
IMB - friable cervix
Excessive discharge - exposed columnar epithelium which produces discharge
What is the most important risk factor for ectropion?
High oestrogen levels - oestrogen mediated conditon
- COCP
- Pregnancy
What is the most common cause of cervicitis?
Trichomoniasis vaginalise
What are the three criteria in PCOS diagnosis and how many are required for a diagnosis?
2 of the following three:
- Oligomenorrhoea
- Clinical or biochemical signs of hyperandogenism
- USS confirmation of polycystic ovaries
What hormonal treatment should be offered in PCOS and why?
COCP - to thin the endometrial lining to prevent hyperplasia.
What are the first, second and third line treatments for a woman with PCOS who is trying to concieve?
First line: clomifene
Second line: metformin
Third line: ovarian drilling
Rarely: letrozole
