Unscheduled bleeding in young women Dr Kathryn Hill GPST2 in O+G.

Slides:



Advertisements
Similar presentations
Managing Heavy Menstrual Bleeding
Advertisements

Contraception in the over 40’s
Dr Kristina Naidoo Consultant Gynaecologist
CONTRACEPTION UPDATE OCTOBER 2011
 Common referral to the menorrhagia clinic  Need to know- what it is - how to diagnose it - recognise red flags - treatments in gp -when to refer 
 Ultrasound pelvis  Full blood count  Pap smear  Coagulation profile  Liver function tests  Serum Iron  Serum ferritin  Endometrial biopsy 
Callum Duncan Consultant Neurologist Aberdeen Royal Infirmary
Periodic Woman Screening Sheet By Periodic Woman Screening Committee January 2010.
Session III: Providing Progestin-Only Injectables
‘Doc I’ve had an accident’ 33 year old Burst condom BMI 35 Wants the morning after pill.
Hormone Replacement Therapy Dr Belinda Magnus. Menopause - Background  Vasomotor symptoms affect around 80% women during the menopause – severe in 20%
Are you up with the LARCs? Dr Christine Roke National Medical Advisor, Family Planning March 2011.
Contraceptive Options for Women and Couples with HIV Implants, POPs and Emergency Contraception.
Gynaecological Cancers
Sample Taker Training Cervical Cytology & Management of Abnormalities.
Dr Catherine Taylor GPST2 Familial Hypercholesterolaemia.
HRT In a nutshell for all the blokes out there. diagnosis  Clinical hx  FSH limited value as levels fluctuate  May be of value in symtomatic women.
Abnormal uterine bleeding
DYSFUNCTIONAL UTERINE BLEEDING
Barbora kubešová. Contraception Techniques to prevent pregnancy - family planning - population control Pearl index … number of pregnancies x.
Post Menopausal Bleeding
Management of Abnormal Vaginal Bleeding
Management of Unscheduled Bleeding
Emergency Contraception, Quick Start & a bit about LARCS
Max Brinsmead MB BS PhD May  Listening to the patient tell her story  Generating a hypothesis  Testing the hypothesis ▪ By interrogation ▪ 50.
Contraception Matthew Dowling 10/9/14.
DR MANAL IDRIS menorrhagia. Introduction Menorrhagia is one of the commenest gynaecological complaints seen in practice and accounts for approximately.
Puberty and Hormones Notes taken by Iris Lau from the 2014 Australian & NZ Dravet Syndrome Family Conference.
CANCER CERVIX A PREVENTABLE CANCER Dr NEETA DHABHAI Sr Consultant. – Gynaecologist Member Expert - Indian Cancer Winners’ Association
Management of Heavy Menstrual Bleeding Dr Sana’a Sabri GP ST1 14/12/2010.
Management of Abnormal Vaginal Bleeding D.W Polson Consultant Obstetrician & Gynaecologist.
Overview of NHS Cervical Screening Programme Cervical Screening QARC Training School October 2012.
MANAGING THE MENOPAUSE SUMMARY HRT appropriate for moderate to severe symptoms HRT appropriate for moderate to severe symptoms HRT should not be.
Monday, August 8 th,  Normal cycle lasts: 26 to 30 days, but may vary from 21 to 35 days  Normal menstrual flow lasts: 3 to 7 days A period.
1 Guildford & Waverley Community Gynaecology Service September 2014 Presented by Dr Helen Barnes.
A BNORMAL UTERINE BLEEDING Dr.Srwa Jamal Murad MBChB,FICOG.
Abnormal Uterine Bleeding Dr Helen Barnes GPSI September 2014.
By: Maureen Jaminal BIOL 316
Dr Sylvia Bond 16/9/09.  1 point type and 1 point brand name  Cyclical( sequential)  CCT ( Continuous Combined Therapy)  Unopposed.
Max Brinsmead MB BS PhD May The common causes are…  Pregnancy-related ○ Miscarriage – threatened, inevitable or incomplete ○ Ectopic  Cervical.
Contraception. Contraceptive effectiveness Sterilization Sterilization Estrogen-Progestin pills Estrogen-Progestin pills Depo-Provera Depo-Provera Male.
Contraception. Contraceptive effectiveness Sterilization Sterilization Estrogen-Progestin pills Estrogen-Progestin pills Depo-Provera Depo-Provera Male.
‘Let’s get it right - Referral for suspected Cancer’
Ovarian and Endometrial Cancer Using risk factors to help triage Adam Rosenthal PhD MRCOG Consultant Gynaecologist and Gynaecological Oncologist.
Hot Topics in Contraception
Suspected cancer: recognition and referral NICE guidelines [NG12] Published date: June 2015 also cancer researchuk Dr Jane Wilcock.
Abnormal Uterine Bleeding
DIVISION OF REPRODUCTIVE AND UROLOGIC PRODUCTS Clinical Trial Design Issues Phill Price MD.
Obs & Gynae Pearl Index: measures the number of pregnancies that occur for each contraceptive method if used by 100 women for one year.  Perfect.
Heavy menstrual bleeding Implementing NICE guidance January 2007 NICE clinical guideline 44.
Contraception in the over 40s Ruth Adams Clinical Educator Leicester Sexual Health.
Max Brinsmead PhD FRANZCOG July The common causes are…  Pregnancy-related ○ Successful but threatening to miscarry ○ Unsuccessful & aborting ○
Early Diagnosis of Gynaecological Cancer Rob Gornall Consultant Gynaecology GHNHST.
Progestogen-only contraception
Hormonal Contraception & Factors Affecting Effectiveness
Hormonal Contraception & Factors Affecting Effectiveness
Functional and symptomatic abnormal uterine bleeding
Combined Oral Contraceptives
Endometrial hyperplasia
Post Menopausal Bleeding
Mr Pratik N Shah MD MRCOG Clinical Director for Womens Services
Progesterone Only Pills (POPS)
Contraception in the over 40’s
Menopause Update Dr Fiona Jacklin April 2018
Case Study 3 - Menorrhagia
GP Education Meeting September 2018
Suspected Gynaecological Cancer Recognition & Referral
Presentation transcript:

Unscheduled bleeding in young women Dr Kathryn Hill GPST2 in O+G

Aims To review the guidelines on the management of abnormal vaginal bleeding in young women To concentrate on the investigation/ management to be carried out before referral to colposcopy clinic

Why is it important? 1/600 women aged 20-24y reported PCB per year 0.5-1% women aged 20-24y present with IMB/ year Estimated 7500 – women will present each year

DoH Clinical Practice Guidelines Women aged 20-24y Abnormal vaginal bleeding relatively common To prevent delay of referral to colposcopy in rare cases of cancer

Management - PCB History Speculum examination If clinically suspicious 2ww If local problem treat or refer If normal for swabs Refer if bleeding persists 6-8 weeks Women over 35y PCB >4w refer colposcopy (Scottish Guidelines)

Management - IMB History If suspected OCP problem – modify contraception If bleeding persists (6-8 weeks) – speculum

FSRH - management of unscheduled bleeding on hormonal contraception Frequent / prolonged / irregular / spotting Many due to method of hormonal contraception Endometrial and cervical cancer rare Early vs late symptoms May not need examination

FSRH - management of unscheduled bleeding on hormonal contraception COCP/ Patch/ Ring: Upto 20% have irregular bleeding in 1 st 3m Usually settles Use lowest oestrogen dose for cycle control May need to increase from 20mcg to 30-35mcg No evidence tricycling settles bleeding Progesterone only Bleeding pattern on one method does not predict bleeding patterns with another method

FSRH - management of unscheduled bleeding on hormonal contraception POP: Early - 30% change in bleeding and 10% irregular Later – 50% regular bleed and 30-40% irregular No evidence changing type of pill will help No evidence that 2 pills per day will help Injectable: 35% amenorrhoeic at 3m and 70% at 1y No evidence reducing interval improves bleeding Mefenamic acid 500mg bd 5d reduced length of bleeding episode. No long term effect.

FSRH - management of unscheduled bleeding on hormonal contraception Implant: At 6m 30% infrequent and 10-20% prolonged bleeding Doxycycline may help but limited evidence IUS: Irregular, light or heavy in 1 st 6m 65% have amenorrhoea or reduced bleeding at 1y No evidence for treatment options Injectable / Implant / IUS: COC upto 3m (usual use or continuous) recommended if not contraindicated

Summary History Consider examination Consider investigation for infections Modify hormonal contraception Refer if persistant bleeding for 6-8 week

References Clinical practice guidance for the assessment of young women aged with abnormal vaginal bleeding. DoH Mar Management of unscheduled bleeding in women using hormonal contraception. FSRH May corp/UnscheduledBleeding pdf corp/UnscheduledBleeding pdf Persistant PCB. RCOG Query bank. guidance/persistent-post-coital-bleeding-query-bank guidance/persistent-post-coital-bleeding-query-bank