Abnormal/Irregular vaginal bleeding

Question 1

On average how much blood is lost per menstural cycle?

Answer 1

<80ml

Question 2

What is menorrhagia?

Answer 2

Heavy or prolonged menstural flow

Question 3

What is metorrhagia?

Answer 3

Regular intermenstural bleeding

Question 4

What is amenorrhoea?

Answer 4

Absence of mensturation >6 months

Question 5

What is oligomenorrhoea?

Answer 5

Menses at intervals of >35 days

Question 6

Causes of AUB in adolescence/early reproductive life?

Answer 6

DUB
Pregnancy/Miscarriage
Endometriosis
Bleeding disorders

Question 7

Causes of AUB post menopause?

Answer 7

Atrophy
Endometrial polyp
Exogenous hormones
Endometriosis
Bleeding disorder

Question 8

What is the difference between organic and non-organic causes of AUB?

Answer 8

organic - presence of pathology

non-organic - absence of pathology (i.e. dysfunctional uterine bleeding)

Question 9

What is adenomyositis?

Answer 9

Endometrial glands and stroma in the myometrium

Question 10

Polyps are common, especially around menopause. What do you have to look out for?

Answer 10

They are mostly bengin

BUT endometrial carcinoma can preset as a polyp

Question 11

How does the coil affect periods?

Answer 11

Progesterone coil= Light periods

Copper coil= Heavy periods

Question 12

What colour does endometriosis present as?

Answer 12

Initially red due to collection of blood, then inflamamtory reaction, fibrosis and then the lesion turns black

Question 13

Why is it rare to see endometritis?

Answer 13

Cervical mucous plug protects endometrium from ascending infection + cyclical shedding makes it relatively resistant

Question 14

What is chronic plasmacytis endometritis associated with?

Answer 14

Pelvic inflammatory disease (PID)

Question 15

Which 3 conditions may present with pain and heavy periods?

Answer 15

ADENOMYOSIS
PID
Endometriosis

Question 16

How do prolactin disorders generally affect periods?

Answer 16

Tend to get amenorrhoea

Question 17

What are the two subdivisions of non-organic bleeding?

Answer 17

Anovulatory

Ovulatory

Question 18

Anovulatory non-organic bleeding. How does this present?

Answer 18

At extremes of reproductive life
Irregular cycle
More common in obese women
CORPUS LUTEUM DOES NOT FORM

Question 19

Ovulatory non-organic bleeding. how does this present?

Answer 19

More common 35-45
Regular heavy periods
Due to inadequate progesterone produced by corpus luteum

Question 20

TRUE/FALSE

TVUS is diagnostic for polys ect

Answer 20

FALSE

It is v helpful but need histology results for diagnosis

Question 21

Possible management of non-organic bleeding

Answer 21

Progesterone-releasing IUCD (Mirena IUS)
Tranexamic acid
Progesterones IM
COCP
Surgery

Question 22

Chat about Mirena

Answer 22

Don’t need to worry about compliance
Lasts for 5 years
Delivered locally so don’t get 1st pass effect
Reduces bleeding
SE- Irregular bleeding for 1st 4-6 months and progesterone effects

Question 23

Which group of people is transexamic acid especially helpful in?

Answer 23

Useful in those trying to conceive as non-hormonal

Question 24

What is the most common gynaecological presentation?

Answer 24

Menorrhagia

Question 25

Which 4 anatomical areas may be a problem if there is amenorrhoea?

Answer 25

Hypothalamus
Pituitary
Ovaries
uterus

Question 26

What age does mensturation usually start?

Answer 26

Age 13

Question 27

What are the two definitions of primary amenorrhoea?

Answer 27

• Failure to have a period before age 14 with no secondary characteritics
• Failure to have a period before age 16 with secondary characteristics

Question 28

If an imperforate hymen is not treated what are two possible complications?

Answer 28

Peritonitis

Endometriosis

Question 29

What is Post menopausal bleeding defined as?

Answer 29

AUB >1 year after cessation of mensturation