Acute heavy menstrual bleeding

Blog Post  by Malcolm G. Munro MD, FACOG, FRCS(c), Professor, Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Director of Gynecologic Services, Kaiser Permanante, Los Angeles Medical Center, Los Angeles, CA, USA

Recently a young healthy woman presented with acute heavy menstrual bleeding (HMB) and was placed on a multidose combination estrogen-progestin oral contraceptive (COC) regimen. As the bleeding stopped she developed central neurological symptoms and findings and was diagnosed with internal jugular venous thrombosis that resulted in profound neurological sequellae. Investigation identified the presence of a previously undiagnosed case of von Leiden factor deficiency. This case provides a suitable backdrop for discussion about acute heavy uterine bleeding, the role for medical therapy, and the potential consequences of high dose estrogenic interventions.

The entity of acute HMB has only recently been defined as heavy uterine flow not associated with pregnancy that is of sufficient volume to require urgent or emergent medical intervention.1  Although research evaluating the causes of this recently defined entity is necessary, it is likely that ovulatory disorders (AUB-O) are the most common cause. However, coagulopathies may also contribute (AUB-C), and, particularly in adolescents with von Willebrand disease, may augment the heavy bleeding associated with perimeharcheal anovulation (AUB-C, -O). Arteriovenous malformations are yet another but admittedly rare entity that can also cause acute HMB. Read more of this post

Abnormal uterine bleeding

Blog Post  by Malcolm G. Munro MD, FACOG, FRCS(c), Professor, Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Director of Gynecologic Services, Kaiser Permanante, Los Angeles Medical Center, Los Angeles, CA, USA

Many medical students, registrars/residents, primary care physicians and even gynecologic specialists struggle when confronted with a patient with abnormal uterine bleeding (AUB) in the reproductive years. This is no surprise as both the investigation and management of abnormal AUB in such women has been hampered by confusing and inconsistently applied nomenclature and the lack of standardized methods for investigation and categorization of the various potential causes of the problem.(1, 2) Terms such as “menorrhagia” and “dysfunctional uterine bleeding” frequently have different meanings in different environments, often resulting in misinterpretation of patients, colleagues, and textbooks or the medical literature. In addition, while many potential causes of AUB are invisible such as endometrial defects or coagulopathies, many uterine entities that are discernable, such as adenomyoais, leiomyomas, and endometrial polyps, are frequently asymptomatic. Read more of this post

What should you read to prepare for MRCOG II Written

Blog Post by Arri Coomarasamy, MBChB, MD, MRCOG, DFFP, lecturer and specialist registrar in obstetrics and gynaecology

As my past course candidates know, I am a great fan of the “Handbook of Gynaecological Oncology” by Shafi, Luesley and Jordan. It summarised all you needed to know about gynae cancers in 277 A5 size pages, with very little padding and fine print, and was as readable and enjoyable as the classic gold standard of Nelson-Piercy’s Handbook of Obstetric Medicine. However, I didn’t recommend this book in 2009; the reason was that it had aged (it was published in 2001). So, imagine my delight when I found a new book “Gynaecological oncology” by Shafi, Earl and Tan! I bought it and have already read half of it, and it is proving to be an absolute pleasure! This book is likely to take  the pain outof your MRCOG oncology revision!  Just like “Mr Muscle” kitchen cleaner, it makes you love the job you hate! I highly recommend it: 205 pages of highly relevant stuff for MRCOG.

Gynaecological Oncology is published by Cambridge University Press

%d bloggers like this: