Abnormal vaginal bleeding Flashcards
(28 cards)
Types of AUB/DUB
- Heavy menstrual bleeding (HMB) = commonest variation of AUB
- Excessive menstrual loss that interferes with the woman’s physical, social, emotional QoL
- Intermenstrual Bleeding (IMB)
- Bleeding in between periods
- Post-coital bleeding (PCB)
- Bleeding after sex
- Post-menopausal bleeding (PMB)
- Bleeding after the menopause (12m after Last Menstrual Period / LMP)
Causes of AUB/DUB
Structural
- Polpys
- Adenomyosis
- Leiomyoma
- Malignancy or hyperplasia
Non-structural
- Coagulopathy e.g. von willebrand (other bleeding symptoms too e.g. gums, epistaxis, bruising)
- Ovulatory disorder
- Endometrial
- Iatrogenic (HRT, copper IUD, anticoags)
Polyp gold standard treatment?
Removal - Polypectomy
What is adenomyosis?
Endometrial-like tissue within the muscle of the women (myometrium)
Adenomyosis symptoms
Heavy menstrual bleeding
Dysmenorrhoea/pelvic pain
What is endometriosis?
Endometrial-like tissue outside of the uterus - chronic oestrogen dependent inflammatory disease
Endometriosis symptoms
Dysmenorrhoea/pelvic pain
Dyspareunia
Dyschezia
Heavy menstrual bleeding
Endometriosis diagnosis investigations
Laprascopy
What is leiyomyoma
fibroids - hormone sensitive benign tumours
Fibroid symptoms
Heavy menstrual bleeding
Dysmenorrhoea
Abdominal distension
Dyspareunia
Pressure on bowel or bladder – urinary or bowel symptoms
subfertility
Leiomyoma Ix
transvaginal ultrasound
Fibroids management
Symptomatic management
Referral if:
- Fibroid > 3cm or suspected submucosal fibroids on scan
- Severe symptoms
- Failed primary care treatment of symptoms
- Suspected fertility issues
- Rapid or unexpected growth of fibroids after menopause
What is endometrial hyperplasia?
abnormal thickening of the uterine lining
What is endometrial cancer dependent on?
Oestrogen
Criteria for urgent referral suspecting endometrial cancer?
- Post menopausal bleeding and not on HRT (after 12 months bleeding free)
- Unscheduled bleeding for 4-6 months after starting HRT
- Abnormal US suggestive of endometrial cancer
TVUS if >55y and
* Unexplained PV discharge – presenting for the first time/thrombocytosis/haematuria
* Visible haematuria and low haemoglobin/thrombocytosis/high blood glucose levels
Endometrial cancer management
Depends on stage
Early-stage disease – total abdominal hysterectomy and bilateral salpingo-oophorectomy
RF for cervical cancer
- Genital HPV infection
- Early age of first sexual intercourse
- Multiple sexual partners
- Lower socioeconomic status
- Smoking
- COCP use
Criteria for urgent referral for suspected cervical cancer
- Appearance of cervix consistent with cervical cancer
- Post coital, intermenstrual or post menopausal bleeding or abnormal persistent vaginal discharge with no infectious cause
When and how often are smear tests done?
- Every 3y from 25-49y
- Every 5y from 50-64y
- Anyone with a cervix
If positive undergo cytology testing, if abnormal, colposcopy referral, if normal cytology repeat smear in 12 months
What is primary amenorrhoea?
Lack of menstruation by the age of 15y (or 13y if also no secondary sexual characteristics)
What is secondary amenorrhoea?
Cessation of menstruation in women who previously had ‘normal’ and established menstrual cycles
Causes of primary amenorrhoea?
Hormonal / Anatomical / Genetic
Causes of secondary amenorrhoea?
MOST COMMON CAUSE - Hypothalamic-pituitary – commonly lifestyle e.g. stress, anorexia, excessive exercise, weight loss
Endocrine – PCOS, hyperprolactinaemia, thyroid
Premature ovarian insufficiency/menopause
Iatrogenic – medication/surgery
Ix for hypothalmic-pituitary cause of amenorrhoea
check BMI and do progesterone challenge
