1. A BNORMAL M ENSTRUATION Matthew Beaumont

2. H EAVY / A BNORMAL M ENSTRUAL B LEEDING Menorrhagia Excessive bleeding in normal cycle Clinical definition: interferes QOL Objective: Blood loss______ml 1/3 women

3. A ETIOLOGY Idiopathic (majority) F________ (30%) Polyps (10%) Adenomyosis Usually irregular: Chronic Pelvic infection Ovarian tumour Endometrial/ cervical malignancy Rare: Thyroid, von Willebrand’s, anticoagulants therapy

4. AMB H X Amount- Flooding? Large clots? Timing Contraception? Menstrual calendar

5. O/E Anaemia Irregularly enlarged uterus= fibroids Tenderness +/- enlargement= adenomyosis Ovarian Mass

6. I NVESTIGATIONS FBC Coagulation + Thyroid T___________U_______ (assess endometrial thickness) Endometrial biopsy (at hysteroscopy or pipelle) Hysteroscopy

7. M EDICAL M ANAGEMENT First line: o I________ Second line: o Antifibrinolytics (___________acid) o NSAIDS o COC 3 rd Line: o Progestogens (oral/ I.M.) o GnRH agonists

8. S URGICAL MANAGEMENT Hysteroscopic: o Poylp resection o Endometrial ablation TCRE- Transcervical resection of endometrium Newer: probe or thermal balloons o (TCRF)- transcervical resection fibroid Radical: o Myomectomy o Hysterectomy o Uterine artery embolisation

9. Intermenstrual bleeding : ______between periods Irregular periods : outside the normal cycle length of 23- 35 days with a variability of >7 days between shortest and longest cycle

10. A ETIOLOGY Extremes of reproductive age PCOS Pelvic pathology: o Fibroids/ Polyps, adenomyosis, ovarian cysts, chronic pelvic infection o Older women: ovarian, cervical, endometrial Malignancy

11. O/e : o speculum- cervical polyp Ix: o FBC o Cervical smear o USS: >35s- malignancy o Endometrial biopsy, Pipelle at hysteroscopy

12. T REATMENT Medical: IUS/COC- regular and lighter HRT (perimenopause) second lines Surgery: Polyp avulsed and examined histologically ablation less helpful

13. P OST COITAL BLEEDING Vaginal bleeding after intercourse (not m____ blood) Hx: Period? First intercourse?

14. A ETIOLOGY Cervical ectropion Polyps Atrophic v_______ Cervical carcinoma

15. O/E: Speculum + Smear: inspect cervix Avulse polyps and send histology Smear abnormal: Colposcopy – exclude malignancy Treat ectropian with cryotherapy