Heavy Menstrual Bleeding Flashcards Preview

Women's Health > Heavy Menstrual Bleeding > Flashcards

Flashcards in Heavy Menstrual Bleeding Deck (38):
1

Average blood loss per menstrual cycle?

35mLs per cycle

2

Average length of menses?

3-7 d

3

What is menorrhagia?

Prolonged (7d+) or excessive (80mLs+ per cycle) occurring at regular intervals

4

What is metrorrhagia?

Irregular cycle and more frequent

5

What is menometrorrhagia?

Prolonged or excessive bleeding occurring at irregular and more frequent intervals

6

What is metros taxis?

Acute, very heavy bleed

7

Ddx of vaginal bleeding?

- DUB
- Systemic: endocrine, bleeding disorders, liver disease)
- Adenomyosis
- Fibroids
- Polyps
- Inection
- Carcinoma
- Iatrogenic
- Pregnancy

8

What is DUB?

No organic pathology; diagnosis of exclusion. May be ovulatory or anovulatory.

9

What is ovulatory DUB?

Aetiology unclear. May be due to excessive prostacyclin production which increases vasodilation and decreases platelet aggregation.

10

What is pathophysiology of anovulatory DUB?

Normal: with ovulation CL makes progesterone
Anovulatory:
- no ovulation, CL does not develop.
- No progesterone produced.
- Unopposed oestrogen = endometrial thickening until outgrows blood supply - necrosis and shedding. Cycles therefore long and irregular. d

11

What are the RFx for anovulatory DUB?

Extremes of reproductive life
- Adolescence
- Perimenopause
But can occur at any stage

12

What are the consequences of anovulatory DUB?

May present with any menstrual pattern.
- Fe deficiency anemia
- Infertility
- If chronic: inc RFx endometrial hyperplasia and cancer

13

Endocrine causes of anovulatory DUB?

- Thyroid
- Pituitary / adrenal disorders
- PCOS
- Significant weight changes

14

What are the uterine and local causes of DUB?

- Myometrium: fibroids, adenomyosis
- Endometrium: polyps, hyperplasia, carcima, endometritis, IUD
- Cervix: polyps, Ca
- Ovarian pathology

15

Proportion of women with fibroids?

20% of 30yo women

16

RFx for fibroids?

- Nulliparity
- Obesity
- +ve FHx

17

Symptoms of fibroids?

Mostly asymptomatic
- Pressure
- Frequency (urinary)
- Menstrual disturbance
- Pregnancy issues
- Pain: if necrosis, torsion

18

Mx fibroids?

- Hormonal if symptomatic
- Hysteroscopic resection if sub mucous
- Myomectomy
- Hysterectomy
- Embolisation / ablation

19

What is adenomyosis?

Endometrial glands within myometrium

20

CFx of adenomyosis?

- Multiparous; 30s/40s
- Menorrhagia
- Dysmenorrhoea
- Bulky, tender uterus

21

Ix of choice in adenomyosis diagnosis?

MRI
USS is insensitive

22

Mx adenomyosis?

- Induce amenorrhoea with hormonal treatment
- GnRH analogues
- Mirena
- Hysterectomy

23

Presentation of endometrial carcinoma?

- PMB
- Menorrhagia
- IMB

24

RFx endometrial carcinoma?

- Chronic anovulatory cycles
- Unopposed oestrogen therapy
- Obesity
- PCOS
- Nulliparous
- Endometrial hyperplasia
- FHx HNPCC
- Tamoxifen

25

How is endometrial cancer diagnosed?

Endometrial sampling

26

Iatrogenic causes of DUB?

- OCP
- Depot provera
- Implanon
- IUD
- Anticoagulation
- Chemotherapy (thrombocytopenia)

27

Bimanual exam features of adenomyosis?

Large, tender, globular uterus

28

What is first line endometrial sampling?

Pipette first line.
- OPD; no anaesthetic
- Normal does not exclude problem

29

What should be done in pipelle endometrial sampling shows malignancy?

If malignancy: refer straight to oncology - no Hysteroscopy D&C

30

Gold standard endometrial sampling to exclude carcinoma or hyperplsia?

Hysteroscopy D & C

31

Risks of Hysteroscopy D&C?

- Uterine perforation
- Infection
- Gas embolism

32

Work up for PMB?

- TV USS and pipelle
- If both normal (ET under 4mm) can observe
- If recurs, or any abnormality: HD&C

33

Medical Mx of HMB?

-Treat cause
-A. Non Hormonal: PG inhibitors, anti-fibrinolytics
-B. Hormonal: OCP, depot provera, GnRH analogues
-C. Procedural: Mirena

34

Surgical Mx of HMB indication?

If medical treatment fails and fertility not desired

35

Surgical Mx of HMB?

- Endometrial ablation
- Hysterectomy

36

Commonest cause of teenagers with HMB?

Anovulatory DUB (80% ovulatory 3y after menarche)

37

metrostaxis Mx?

- ABCs; resuscitate
- Tranexamic acid first line
- High dose progesterone acutely

38

Hx to elicit when evlaluating HMB?

- Age
- Parity
- LNMP and ?preg
- frequency / vol / pattern
- Impact on QoL
- Comorbidities (diabetes, obesity, PCOS, thyroid disease, bleeding disorders)
- Pelvic pain or pressure
- Fhx: endometriosis, endometrial or bowel cancer