Intermenstrual, Breakthrough, and Post-coital Bleeding Flashcards Preview

B - Gynaecology > Intermenstrual, Breakthrough, and Post-coital Bleeding > Flashcards

Flashcards in Intermenstrual, Breakthrough, and Post-coital Bleeding Deck (40)
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

What investigations can be made into women with abnormal pre-menopausal vaginal bleeding?

- Pregnancy test
- Infection screen
- Blood tests
- Transvaginal USS
- Endometrial bopisy

31

What blood tests can help identify a cause of abnormal pre-menopausal vaginal bleeding?

- FBC
- Clotting
- TFTs
- FSH/LH

32

What can a transvaginal USS look for in a woman with abnormal vaginal bleeding?

Structural abnormalities

33

What does management of abnormal pre-menopausal vaginal bleeding depend on?

The type and cause of the bleeding

34

What is the first management step if cancer is the suspected cause of abnormal pre-menopausal vaginal bleeding?

Urgent referral for further investigation

35

What are the management steps if infection is the suspected cause of abnormal pre-menopausal vaginal bleeding?

Antibiotics (if appropriate) and contact tracing

36

What is the management if hormonal contraception is considered to be the cause of abnormal pre-menopausal vaginal bleeding?

Advise that it is normal in the first 3 months but can swap if persistent

37

How can cervical ectropion be treated?

- Conservatively
- Cauterisation

38

How is cervical ectropion cauterised?

With silver nitrate

39

How should cervical polyps be managed?

Evulsed and sent for histology

40

How can fibroids be managed?

- Hysteroscopic removal for small fibroids
- Uterine artery embolisation
- Medical management with oestrogen reducing drugs