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