Flashcards in Intermenstrual, Breakthrough, and Post-coital Bleeding Deck (40)
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1
What is intermenstrual bleeding (IMB)?
Vaginal bleeding at any time during the menstrual cycle other than during normal menstruation
2
What can IMB be difficult to distinguish from sometimes?
Metrorrhagia
3
What is metrorrhagia?
Irregularly frequent periods
4
What is post-coital bleeding (PCB)?
Non-menstrual bleeding that occurs immediately after sexual intercourse
5
What is breakthrough bleeding?
Irregular bleeding associated with hormonal contraception
6
What are IMB and PCB classified as?
Symptoms
7
What is the result of IMB and PCB being symptoms?
They require further investigation
8
What is the biggest differentiator of causes of abnormal bleeding?
Age
9
What is an uncommon cause of PV bleeding in young women?
Malignancy
10
What happens to the likelihood of uterine polyps and fibroids with age?
Increases
11
What are the possible causes of PCB?
- Infection
- Cervical ectropion
- Cervical or endometrial polyps
- Vaginal cancer
- Cervical cancer
- Trauma or sexual abuse
- Vaginal atrophic change
12
What % of women with PCB have no specific cause found?
50%
13
What are the possible causes of intermenstrual bleeding?
- Pregnancy related
- Physiological
- Vaginal causes
- Cervical causes
- Uterine causes
- Iatrogenic causes
14
What pregnancy related causes can lead to IMB?
- Ectopic pregnancy
- Gestational trophoblastic disease
15
What can be a physiological cause of IMB?
Spotting during ovulation
16
What % of women have spotting during ovulation?
1-2%
17
What are the vaginal causes of IMB?
- Adenosis
- Vaginitis
- Tumours
18
What are the cervical causes of IMB?
- Infection
- Cancer
- Cervical polyps
- Cervical ectropion
19
What infections of the cervix can cause IMB?
- Chlamydia
- Gonorrhoea
20
What are the uterine causes of IMB?
- Fibroids
- Endometrial polyps
- Cancer
- Adenomyosis
- Endometriosis
21
What are the iatrogenic causes of IMB?
- Tamoxifen
- Following smear or cervix treatment
- Missed OCP
- Drugs altering clotting
22
What drugs that alter clotting can cause IMB?
- Anti-coagulants
- SSRIs
- Corticoteroids
23
When is breakthrough bleeding most common?
When a new contraceptive is started, and often settles without intervention
24
What type of hormonal contraceptives are more likely to cause bleeding problems?
Progesterone only
25
What should be asked about when taking a history for abnormal pre-menopausal vaginal bleeding?
- Menstrual history
- Obstetric history
- Gynaecological history
- Sexual history
- Medical history
- Current medication
26
What should be examined when assess abnormal pre-menopausal vaginal bleeding?
- BMI
- Abdomen
- Speculum
- Bimanual
27
What can be looked for on abdominal examination when a patient presents with abnormal pre-menopausal vaginal bleeding?
Presence of any pelvic masses
28
What should be looked for on vaginal examination in a woman with abnormal pre-menopausal vaginal bleeding?
Any obvious genital tract pathology
29
What are some common findings on vaginal examination in abnormal pre-menopausal vaginal bleeding?
- Cervical ectropion
- Cervical polyp
- Cervicitis
30
