Gyn Chapter 7: Vaginal Bleeding

Front 1

Vaginal Bleeding with Negative Pregnancy Test

Back 1

1. Premenarche bleeding

2. Intermenstrual bleeding in fertile female

3. Bleeding after menopause

Front 2

Premenarche Bleeding

Back 2

Precocious Puberty:

-enlarged breast (gynecomastia)

-hair in the pubis

Front 3

Intermenstrual bleeding in fertile female

Back 3

1. retained products of pregnancy

2. retained menstrual products in cesarian scar

3. endometrial fibroids

4. intracavitary mass as polyp, cancer or endometrial hyperplasia

5. adnexal masses as hormone secreing tumors

Front 4

Bleeding after menopause

Back 4

1. recurrence of menstruation

2. endometrial atrophy

3. HRT

4. Tamoxafin

5. endometrial cancer

Front 5

Endometrial fibroids or intracavitary type

Back 5

maybe a cause of heavy inter menstrual spotting or postmenopausal bleeding. By SIStechnique they appear with smooth, mildly echogenic border and less echogenicinternal contents. They are usually immobile

Front 6

Endometrial Polyp

Back 6

Manyare asymptomatic but some are present with heavy periods or intra-menstrualbleeding.They appear round and echogenic with irregular border by the SIS technique.Color flow shows a single vessel supplying it (this favors a benign origin ofthe polyp)

Front 7

Adnexal Mass

Back 7

Manyare asymptomatic but some are present with heavy periods or intra-menstrualbleeding.They appear round and echogenic with irregular border by the SIS technique.Color flow shows a single vessel supplying it (this favors a benign origin ofthe polyp)

Front 8

Cesarian Section Scar

Back 8

Itis filling of the pouch related to the scar of Cesarian section by blood at the time ofmenstruation. This leads to leakage of old dark blood over next few dayscausing intermenstrual spotting.

Front 9

Retained Product of Conception

Back 9

•occursafter recent pregnancy terminated electively or by vaginal delivery

•Endovaginal examination show echogenic material in the endometrial cavity.Color flow Doppler show activity due blood supply to the retained tissue

Front 10

Endometrial Cancer

Back 10

mostcommon after menopause. It is associated with abnormal bleeding. appear as echogenic sessile mass withwide base. It is highly vascular with many supplying vessels (differentiatedfrom endometrial polyp by number of feeding vessels). Fluid in the uterine cavity mayindicates an underlying neoplasm.

Front 11

Benign Endometrial Hyperplasia

Back 11

Generalizedor localized Thickening of the endometrium >8 mm. It appears echogenic withsmall cysts. It is usually seen around the time of menopause.

Front 12

Recurrence of Apparent Menstruation after an interval of months or years

Back 12

Theendometrium may appear thick or with cystic formation.

Front 13

Atrophic endometrium

Back 13

Aftermenopausalthe endometrium measures only 4 mm or less. This atrophic endometrium can bleedspontaneously

Front 14

Postmenopausal hormone replacement therapy (HRT)

Back 14

Takingestrogen alone as a replacement hormonal therapy causes endometrial hyperplasiawith tendency to bleed. HRT should be a combination of estrogen andprogesterone. HRT has its side effect of developing cancer breast, that is whyit is not used frequentlylately.

Front 15

Tamoxifen

Back 15

Tamoxifen is amedication that is used for treatment of cancer breast. It may lead toendometrial changes in the form of cystic and echogenic areas similar toendometrial hyperplasia or multiple polyps which may be very large.