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OnG > Heavy menstrual bleeding > Flashcards

Heavy menstrual bleeding Flashcards

1
Q

Definition of uterine fibroid

A
  • Benign tumor of uterine smooth muscle (leiomyoma)
  • Estrogen dependent
  • Reproductive age
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2
Q

Classification of uterine fibroid

A
  • Submucous
  • Intramural
  • Subserous
  • Pedunculated
  • Cervical
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3
Q

Risk factor for uterine fibroid

A
  • Reproductive age
  • Nulliparity
  • Obesity
  • Family history
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4
Q

Symptoms of uterine fibroid

A
  • Asymptomatic (majority)
  • Menorrhagia
  • Anemic symptoms
  • Pressure symptoms
    Bladder: frequency, retention
    Rectum: constipation
    Pelvic vein: leg edema, hemorrhoid, varicose vein
  • Pain: in acute degeneration
  • Subfertility
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5
Q

PE finding of uterine fibroid

A
  • General: signs of anemia
  • Abdominal: mass (firm, smooth, non-tender)
  • Bimanual: differentiate uterine fibroid from ovarian mass
  • Speculum: r/o local lesion (cervical polyp), any bleeding from os, vaginal discharge
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6
Q

Difference between ovarian and uterine mass

A

> Uterine

  • Firm
  • Suprapubic
  • Can’t get below
  • Cervix moved from vaginal finger @ bimanual

> Ovary

  • Cystic
  • Iliac fossa
  • Can get below
  • Do not move from vaginal finger
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7
Q

Investigation for uterine fibroid

A

> Blood

  • FBC: anemia due to menorrhagia
  • BUSE/ Cr: may compress ureter, causing hydronephrosis
  • UPT: exclude pregnancy
  • TFT: exclude hypothyroidism
  • Coagulation profile: exclude bleeding disorder

> Imaging

  • Ultrasonography: details of mass, endometrial thickness, exclude hydronephrosis
  • Diagnostic hysteroscopy: look for fibroid, polyp, allow biopsy
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8
Q

Management of uterine fibroid

A

> Medical

  • Hormonal: GnRH agonist, COCP
  • Non-hormonal: tranexamic acid, mefenamic acid

> Surgery

  • Conservative: myomectomy, hysteroscopic removal, uterine artery embolization
  • Definitive: hysterectomy
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9
Q

Indication of surgical management in fibroid

A
  • Causing symptoms
  • Distort uterine cavity and likely to complicate future pregnancy
  • Grow rapidly
  • Infertility
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10
Q

Indication of hysterectomy in fibroid

A
  • Women over 40 y/o
  • Fertility not desired
  • Severe bleeding during myomectomy
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11
Q

Complication of fibroid in pregnancy

A
  • Miscarriage
  • Premature labor
  • Malpresentation
  • Obstructed labor
  • Postpartum hemorrhage
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12
Q

Clinical features of adenomyosis

A
  • Increasing severe menorrhagia
  • Dysmenorrhea
  • Dyspareunia
  • Urinary frequency
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13
Q

Management for adenomyosis

A

> Definitive
- Hysterectomy

> Uterus-sparring

  • Hormonal medication for menorrhagia (eg: levonorgestrel IUD)
  • Uterine artery embolization
  • Uterus-sparring resection
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14
Q

Risk factor of endometriosis

A
  • Low birth weight
  • Early menarche
  • Late menopause
  • Genetics
  • Red meat
  • Obesity
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15
Q

Clinical feature of endometriosis

A
  • Menorrhagia
  • Severe dysmenorrhea
  • Deep dyspareunia
  • Infertility
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16
Q

Definition of dysfunctional uterine bleeding

A

Any variation from normal uterine bleeding:

  • Frequency
  • Regularity
  • Duration
  • Volume
17
Q

Cause of dysfunctional uterine bleeding

A

“PALM-COEIN”

  • Polyp
  • Adenomyosis
  • Leiomyoma
  • Malignancy and hyperplasia
  • Coagulopathy
  • Ovulatory dysfunction
  • Endometrial dysfunction
  • Iatrogenic
  • Not otherwise classified
18
Q

Causes of heavy menstrual bleeding

A
  • Coagulopathy
  • Endocrine disorders (eg: hypothyroidism, hyperthyroidism)
  • Structural lesions (eg: polyps, fibroids)
  • Medication (eg: anticoagulant, platelet inhibitors, NSAIDs)
19
Q

Management of endometrial hyperplasia

A

> Premenopausal
- Progesterone (eg: IUCD, COCP): reverse EH by stromal decidualization and subsequent thinning of the endometrium

> Postmenopausal

  • Progesterone
  • Hysterectomy
20
Q

Indication for hysterectomy in endometrial hyperplasia

A
  • Progestin therapy is declined or contraindicated
  • Those with bothersome bleeding
  • At highest risk of developing endometrial carcinoma
  • Those who desire definitive therapy
21
Q

Disadvantage of GnRH agonist

A
  • Expensive
  • When stopped ,regrow within few months
  • Alter surgical plane and make surgery more difficult
  • Smaller fibroid become indistinct missed during surgery -> increase recurrence rate
22
Q

Why do Hysterectomy and not TAHBSO in fibroid patient

A
  • Bilateral oophorectomy in premenopausal increase risk of fracture, multiple morbidity, cardiovascular disease and neurologic dysfunction
  • However. got risk of ovarian ca if ovaries are preserved
23
Q

Complication of UAE

A
  • Fever
  • Infection
  • Fibroid expulsion
  • Potential ovarian failure
24
Q

Specific sign for endometriosis

A
  • Focal tenderness on vaginal examination
  • Nodules in the posterior fornix
  • Adnexal masses
  • Immobility or lateral placement of the cervix or uterus

OnG (14 decks)

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