Heavy Menstrual Bleeding

Question 1

Heavy Mentrual Bleeding?

Answer 1

Guided by patient perceived problem

Usually >80ml per cycle

Question 2

Causes of vaginal bleeding, don’t ever forget?

Answer 2

Pregnancy

Trauma

Question 3

PALM-COIEN Classification

Answer 3

Palm - structural

COEIN -

Question 4

Polyps are?

Answer 4

Usually asymptomatic

Question 5

Adenomyosis is?

Answer 5

Endometrial glands within myometrium

Question 6

When Adenomyosis?

Answer 6

Late 30s and 40s

Large bulky uterus

Question 7

Fibroids during preg?

Answer 7

May grow in response with hormones

May obstruct delivery

Question 8

Heavy bleeding Rx?

Answer 8

• Suppress the endometrium

- hormones usually.

Question 9

PALM COEIN

Answer 9

Polyps
Adenomyosis
Leiomyoma 
Malignancy
-
Coagulopathy
Ovulatory Dysfunction
Endometrial
Iatrogenic
Not yet Classified

Question 10

COEIN is?

Answer 10

Nonstructural causes of HMB

Question 11

What is the constant phase in menstrual cycle?

Answer 11

LuteaL phase (14 days)

Question 12

Endometrial dysfunction, why?

Answer 12

Popular: too much prostacyclin

Question 13

Ovulatory dysfunction?

Answer 13

Long irregular, no ovulation, no signal to menstruate

Question 14

Consequences of ovulatory dysfunction?

Answer 14

Subfertility

Question 15

Endocrine causes?

Answer 15

Thyroid
Pituitary or adrenal disease
PCOS - hormone variation, lifestyle
Weight changes - loss, or gain

Question 16

Break through bleeding with COC why?

Answer 16

Pill causes lining to be too thin.

Or incomplete suppression of HPO axis

Question 17

Other reasons for bleeing?

Answer 17

Endometriosis

Question 18

Most common reason for pain with menstruation

Answer 18

Prostaglandin related

Question 19

Smears and constant bleeding?

Answer 19

Pap smear in case it’s cervical cancer

Do a thin prep

Question 20

Ix for HMB?m

Answer 20

Iron studies
BHCG
FBE
Coags
Bleeding profile?
TFTs
FSH, LH, estradiol, androgen screen (PCOS)

Question 21

Imaging for HMB?

Answer 21

U/S

Question 22

What is pipelle?

Answer 22

Small suction device, goes through cervix to take endometrial sample

Question 23

What is gold standard for endometrial sampling?

Answer 23

Hysteroscopy D&C

Distended with saline/C02

Question 24

When do endometrial sampling?

Transvaginal U/S and Pipelle?

Answer 24

Woman >40 with HMB

Or post menopausal bleeding

Question 25

Best way to turn off periods?

Answer 25

Monophasic pills, same dosage and skip sugar pills

Question 26

Total hysterectomy is?

Answer 26

Including cervix

Question 27

Special scenarios?

Answer 27

Teenagers Vitals Can decompensate quickly if heavy blood loss

Question 28

Which type of fibroid is most likely to cause heavy bleeding?

Answer 28

Su mucosal

Question 29

Which type of fibroid is most likely to cause heavy bleeding?

Answer 29

Su mucosal