1 / 41

Abnormal Uterine Bleeding

Abnormal Uterine Bleeding. Martin DeBono & Lisa Pickles (consultant, O&G) (GP). NICE guidance: Heavy Menstrual Bleeding 2007. Be aware of this – complements our guidance. ABNORMAL UTERINE BLEEDING. 1/ Menorrhagia. 2/.

phylicia
Télécharger la présentation

Abnormal Uterine Bleeding

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Abnormal Uterine Bleeding Martin DeBono & Lisa Pickles (consultant, O&G) (GP)

  2. NICE guidance: Heavy Menstrual Bleeding 2007. Be aware of this – complements our guidance.

  3. ABNORMAL UTERINE BLEEDING 1/ Menorrhagia 2/ Irregular Bleeding 3/ Postmenopausal Bleeding 2a <40years old 2b >40 years old

  4. ABNORMAL UTERINE BLEEDING 1/ Menorrhagia 2/ Irregular Bleeding 3/ Postmenopausal Bleeding 2a <40years old 2b >40 years old

  5. 1/ Menorrhagia- summary of guidelines. Regular, heavy bleeds with normal examination, no need for hysteroscopy. Treatment options: - TXA, MFA, COC - Mirena - Depo provera Refer GYNAECOLOGY OPD if all options fail (to discuss surgical management)

  6. Surgical Treatments for Menorrhagia. Normal uterus +/- small fibroids <3cm diameter Other treatments failed. No desire to retain uterus. Fibroids >3cm diameter. Normal uterus +/- small fibroids <3cm diameter. Hysterectomy (vaginal if poss.) Endometrial ablation. Treat the Fibroid Myomectomy Uterine artery embolisation

  7. ABNORMAL UTERINE BLEEDING 1/ Menorrhagia 2/ Irregular Bleeding 3/ Postmenopausal Bleeding 2a <40years old 2b >40 years old

  8. 2/ Irregular Bleeding – summary of guidelines. 2a/ <40years UNLIKELY to needhysteroscopy. Causes: Contraception? Infection? Cervix? PCOS? 2b/ > 40years MAY need hysteroscopy(expanded on next slide) Causes: Malignancy? Perimenopause? HRT?

  9. 2b/ > 40years old (irregular bleeding) Work out SIGNIFICANCE of bleeding. Significant IMB Continual spotting No recognisable cycle Not significant No IMB Period-like flow Recognisable periods, even if irregular, short or long cycle. Hysteroscopy Observe then? hysteroscopy

  10. ABNORMAL UTERINE BLEEDING 1/ Menorrhagia 2/ Irregular Bleeding 3/ Postmenopausal Bleeding 2a <40years old 2b >40 years old

  11. ABNORMAL UTERINE BLEEDING 1/ Menorrhagia 2/ Irregular Bleeding 3/ Postmenopausal Bleeding 2a <40years old 2b >40 years old

  12. Risk factors for endometrial carcinoma. Remember these : Obesity PCOS Diabetes Hypertension. Infertility/nulliparous Tamoxifen Early menarche/late menopause. FH ca colon/emdometrium

  13. ABNORMAL UTERINE BLEEDING 1/ Menorrhagia 2/ Irregular Bleeding 3/ Postmenopausal Bleeding 2a <40years old 2b >40 years old

  14. 3/ PMB – summary of guidelines URGENT referral DAPH. ( Direct Access Programmed Hysteroscopy. May have transvaginal scan for endometrial thickness. If >4mm then hysteroscopy).

  15. Notes re DAPH for problem bleeding 1 referral urgency Urgent < 2 weeks post menopausal bleeding high suspicion of uterine cancer, eg suspicious examination, multiple risk factors for endometrial Ca with significant bleeding. Soon Perimenopausal bleeding – significant (see earlier descriptors) Routine 13 week Normal examination Perimenopausal, persistent, not significant bleeding 2 contraindications to hysteroscopy Pregnancy, Recent PID, Cervical pathology (refer to Colposcopy OPD)

  16. Abnormal vaginal bleedingCase QuizWhen to refer for hysteroscopy

  17. Answer a/ no action or medical management b/refer hysteroscopy c/other (assume normal exam,swabs,smear, preg test etc unless otherwise stated) 1/. 50 year old. Cycle heavy 5-7/20-35.

  18. Answer a/ no action or medical management b/refer hysteroscopy c/other (assume normal exam,swabs,smear, preg test etc unless otherwise stated) 2/. 35 year old with menorrhagia (no IMB). Not responded to medical management including mirena coil.

  19. Answer a/ no action or medical management b/refer hysteroscopy c/other (assume normal exam,swabs,smear, preg test etc unless otherwise stated) 3/. 30year old with heavy periods and mid cycle bleeding

  20. Answer a/ no action or medical management b/refer hysteroscopy c/other (assume normal exam,swabs,smear, preg test etc unless otherwise stated) 4/. 45 year old.Regular cycle 5/28. LMP started after 21 day cycle, now spotting or brownish loss for 5 weeks since then.

  21. Answer a/ no action or medical management b/refer hysteroscopy c/other (assume normal exam,swabs,smear, preg test etc unless otherwise stated) 5/. 41 year old. Cycle regular 6/26-30 with spotting in between for past 6/12.

  22. Answer a/ no action or medical management b/refer hysteroscopy c/other (assume normal exam,swabs,smear, preg test etc unless otherwise stated) 6/. 49 year old. Cycle 5-7/28-56 for past year. LMP-flooding for 2 days, normal loss for 3 days, then stopped

  23. Answer a/ no action or medical management b/refer hysteroscopy c/other (assume normal exam,swabs,smear, preg test etc unless otherwise stated) 7/. 46 year old.Cycle 5-7/20-35. LMP started after 28 day cycle, flooding for 2 days and now spotting, brown loss , which has continued for 2 weeks.

  24. Answer a/ no action or medical management b/refer hysteroscopy c/other (assume normal exam,swabs,smear, preg test etc unless otherwise stated) 8/. 55 year old with vaginal dryness. LMP 5 years ago. Atrophia on examination. Reports brown/red streaky loss for 3 months on and off.

  25. Answer a/ no action or medical management b/refer hysteroscopy c/other (assume normal exam,swabs,smear, preg test etc unless otherwise stated) 9/. 52 year old. LMP 14 months ago. Reports a period for 5 days.

  26. GREY AREAS Assume normal exam, swabs, smear, preg test etc unless stated 1/ 37 year old, obese, diabetic, PCOS, with IMB.

  27. GREY AREAS Assume normal exam, swabs, smear, preg test etc unless stated 2/ 52 year old. Had period 9/04. 2/06. Seen 6/06 when above symptoms reported.

  28. GREY AREAS Assume normal exam, swabs, smear, preg test etc unless stated 3/ 84 year old with vaginal dryness, LMP 25 years ago. OE/ atrophia. Reports brown/red loss on and off for 3 months.

  29. GREY AREAS Assume normal exam, swabs, smear, preg test etc unless stated 4/ 41 year old. Regular menorrhagia. Hb=9.1 (microcytic).

  30. Comments 1/ Place of ultrasound? 2/ Norethisterone ? In menorrhagia. ? In irregular bleeding.

  31. Comments – contd: 3/ Anaemia ? Refer or not. 4/ Adnexal mass & irregular bleeding: -?urgent hysteroscopy -? 2 week gynae cancer referral

  32. Summary/key messages Regular menorrhagia does not usually need hysteroscopy. In over 40s, think about SIGNIFICANCE of irregular bleeding: significant – IMB, not recognisable as period (refer) not significant – No IMB, period-like flow (may not need referral). PMB needs urgent DAPH (may have US scan)

  33. ?? QUESTIONS??

  34. References. • Nice Guidance: Heavy menstrual bleeding. January 2007. • Abnormal Vaginal Bleeding – primary care pathway, Calderdale. Find this on Pennine website. ( www.pennine-gp-training.co.uk ). March 2007.

More Related