Flashcards in Abnormal vaginal bleeding Deck (13):
Define: menorrhagia, polymenorrhagia, metorrhagia, premenarchia, postmenopausal
Menorrhagia: menstrual blood loss of >80 mL per cycle
Polymenorrhoea: menstruation more frequent than every 3 weeks
Metrorrhagia: abnormal uterine bleeding between menstrual periods
Premenarchal bleeding: vaginal bleeding that occurs before a girl is 9 years old
Postmenopausal bleeding: vaginal bleeding that occurs >12 months after menopause has been established.
Questions may include:
When did symptoms start and how long do they last?
Does the patient think the bleeding is excessive and is it interfering with normal life?
Are there any associated symptoms such as pain, fatigue, dyspnoea on exertion, or unexplained weight loss?
Is there intermenstrual or postcoital bleeding?
What is the possibility of the patient having an STD?
Could she be pregnant? If she is pregnant, does she have any pain associated with the bleeding
Does the patient use contraceptives; if so, which ones and for how long?
What is the result of the last smear test (if she has ever had one)?
Is there a known history of uterine pathology such as leiomyomas (fibroids), endometrial polyps, and adenomyosis (endometrial glandular growth into the myometrium)?
Is the patient taking any medication, such as anticoagulants, corticosteroids, HRT, or herbal supplements?
Does the patient bruise easily, is minor wound bleeding prolonged, and is there a family history of coagulation disorders?
Dysuria, frequency, hematuria?
-Liver disease stigmata
Serum or urine pregnancy
Maternal Rh/antibodies-may require anti-D
FBC- anemia, malignancy
TSH, prolactin, Testosterone/Progesterone/LH, liver- if indicated
When is TVUS useful and TAUS
Endometrial thickness warranting endometrial biopsy
When is hysteroscopy warranted
Endometrial cavity pathology suspected
Placental abruption, placenta praevia
Medical management for non-pregnancy, repro age women, hemodynamically stable, need urgent control of bleeding
High dose estrogen->acute
GnRH agonist->Leuprolide depot->in prep for surgery
NSAID- mefenamic acid