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