Management of Abnormal Vaginal Bleeding

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Management of Abnormal Vaginal Bleeding

• D.W Polson Consultant Obstetrician
  Gynaecologist

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Management of Abnormal Vaginal Bleeding

• What is Normal?
• What is Abnormal?
• Age Related Management
• Discussion

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Normal Menstrual Cycle

• Bleeding 5 Days
• Menstrual cycle 28 days
• No other bleeding
• Dependent on normal cyclical ovarian function

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What is Normal?

• Duration 2-7 days
• Cycle length 22-35 days
• Number of pads used 3 9
• Mid-cycle spotting - common

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Problems in Teenagers

• Irregular periods
• Menorrhagia / dysmenorrhoea
• Investigations None
• Management Combined Pill

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Problems in 20-30 year olds

• Not Common
• Iatrogenic IMB /PCB whilst taking the combined
  pill
• Menorrhagia
• Investigations Pelvic ultrasound for
  endometrial thickness

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Problems in 30 40 year olds

• Menorrhagia more common
• Examination ? Fibroids
• Investigations FBC
• - Ultrasound
• Management O C Pill
• - medical
• - surgical

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Problems in 40 50 year olds

• Increasingly more common
• Menorrhagia / I.M.B / Irregular cycle
• Investigations FBC
• - Day 2 FSH / Oestradiol
• - Ultrasound
• - ? endometrial biopsy
• Management o c pill
• - Norethisterone
• - medical
• - surgical

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Problems in the gt 50s

• Post menopausal bleeding
• Examination and pelvic ultrasound
• Endometrial thickness biopsy if indicated
• Management Topical oestrogen
• - surgery

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Medical Management of Menorrhagia

• Weight reduction
• Combined pill
• Mefenamic Acid
• Tranexamic Acid 1gm tds
• Norethisterone D5-25
• Mirena IUS
• GnRH agonist therapy

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Summary

• Abnormal vaginal bleeding is a common problem
• Usually related to ovulatory dysfunction and not
  malignancy
• Medical management usually successful
• Mirena and MEA now effective alternatives to
  hysterectomy