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