Menstrual Dysfunction

Question 1

Heavy Bleeding

Answer 1

HMB is defined as excessive menstrual blood loss which interferes with a woman’s physical, social, emotional and QOL.

Hx - age, is bleeding regular, pain / heaviness, urinary frequency, bleeding disorder, thyroid dysfunction, anti coagulants etc

Question 2

> 45

Answer 2

URGENT REFERRAL FOR ENDOMETRIAL ASSESSMENT

Question 3

Hysteroscopy + endometrial biopsy

Answer 3

> 45
No response to medical tx
Persistent intermenstrual bleeding 
Abnormalities during examination
Postmenopausal bleeding

Question 4

Abnormal Uterine Bleeding - causes very accordfing to age

PREGNANCY AND STIs!

Answer 4

Polyp
Adenomyosis
Leiomyoma
Malignancy
Coagulopathy
Ovarian dysfunction
Endometrial process
Iatrogenic
Not yet classified

Question 5

Fibroids

Answer 5

Proliferation of smooth muscle cells - benign, hormonally responsive

Intramural / suberosal / submucosal

Often asymptomatic, menorrhagia, pelvic pressure, dysmenorrhoea

If large can be palpated - compare to pregnancy / finger breadths from umbilicus

Question 6

Tx

Answer 6

If bleeding is main symptom - oral contraception / mirena? / tranexamic acid, progestins, prostaglandin synthase inhibitors, GnRH agonists

Surgical - uterine artery embolization, myomectomy, hysterectomy

Question 7

Endometrial ablation

Answer 7

Used to treat abnormally heavy bleeding

Destroying endometrium

Only recommended in women who do not wish for future pregnancies

Question 8

2ww - red flags (heavy menstrual bleeding)

Answer 8

Age > 45
Persistent intermenstrual bleeding 
Post coital bleeding
Uterine enlargement 
Pelvic mass
Lesion on cervix 
Post-menopausal bleeding