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Management of Abnormal Vaginal Bleeding

Management of Abnormal Vaginal Bleeding. D.W Polson Consultant Obstetrician & Gynaecologist. Management of Abnormal Vaginal Bleeding. What is Normal? What is Abnormal? Age – Related Management Discussion. Normal Menstrual Cycle. Bleeding 5 Days Menstrual cycle 28 days

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Management of Abnormal Vaginal Bleeding

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  1. Management of Abnormal Vaginal Bleeding D.W Polson Consultant Obstetrician & Gynaecologist

  2. Management of Abnormal Vaginal Bleeding • What is Normal? • What is Abnormal? • Age – Related Management • Discussion

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

  4. What is Normal? • Duration 2-7 days • Cycle length 22-35 days • Number of pads used 3 – 9 • Mid-cycle spotting - common

  5. Problems in Teenagers • Irregular periods • Menorrhagia / dysmenorrhoea • Investigations –None • Management – Combined Pill

  6. Problems in 20-30 year olds • Not Common • Iatrogenic IMB /PCB whilst taking the combined pill • Menorrhagia • Investigations – Pelvic ultrasound for endometrial thickness

  7. Problems in 30 – 40 year olds • Menorrhagia – more common • Examination ? Fibroids • Investigations – FBC - Ultrasound • Management – O C Pill - medical - surgical

  8. 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

  9. Problems in the > 50’s • Post menopausal bleeding • Examination and pelvic ultrasound • Endometrial thickness – biopsy if indicated • Management – Topical oestrogen - surgery

  10. Medical Management of Menorrhagia • Weight reduction • Combined pill • Mefenamic Acid • Tranexamic Acid – 1gm tds • Norethisterone – D5-25 • Mirena – IUS • GnRH agonist therapy

  11. 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

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