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13.06.06 The three key gynae things

Menorrhagia
  • Hormonal
    • Anovulatory cycles 
  • Uterine
    • Fibroids
    • Endometrial polyps
    • Adenomyosis
      • Ectopic glandular tissue found in muscle
    • Endometritis
      • Inflammation of the endometrium
    • Endometrial hyperplasia
    • Pelvic inflammatory disease
    • Endometrial carcinoma 
  • Systemic
    • Bleeding disorder
    • Thyroid
    • Liver failure
    • Kidney failure
  • Iatrogenic
    • Copper coil
    • Anticoagulants
  • Unknown
    • DUB - 40-60% of cases

Post-menopausal bleeding
  • Non-gynaecological 
    • Trauma 
    • Bleeding disorder
  • Hormonal
    • HRT
  • Vulva
    • Carcinoma
  • Vagina
    • Atrophic vaginitis
  • Cervical
    • Carcinoma
    • Polyps
  • Uterine
    • Endometrial hyperplasia
    • Endometrial carcinoma
    • Endometrial polyps
    • Endometrial atrophy
    • Uterine sarcoma
  • Ovarian
    • Ovarian carcinoma (especially oestrogen-secreting (theca cell) ovarian tumours)

Secondary amenorrhoea
  • No signs of androgen excess
    • Physiological (Pregnancy, lactation, menopause)
    • Premature ovarian failure
    • Depot and implant contraception
    • Progesterone-only pill
    • Cervical stenosis and intrauterine adhesions
    • Asherman's syndrome
    • Loss of weight
    • Female athlete triad (eating disorder, amenorrhoea and osteoporosis)
    • Hyperprolactinaemia (pituitary disease or drugs)
    • Sheehan's syndrome (hypopituitarism caused by ischemic necrosis due to blood loss and hypovolemic shock during and after childbirth)
    • 'Post-pill amenorrhoea'
  • Signs of androgen excess
    • Polycystic ovarian syndrome 
    • Cushing's syndrome
    • Late-onset congenital adrenal hyperplasia
    • Adrenal or ovarian carcinoma


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