TEALE FENNING Medical Education    FAQ   Search   Memberlist   Usergroups   Register   Profile   Log in to check your private messages   Log in  mrcog courses for doctors Dysfunctional uterine bleeding          TEALE FENNING Forum Index -> Key Facts in O&G View previous topic :: View next topic   Author Message EMAK Century Club Joined: 26 Nov 2006 Posts: 572 Posted: Fri May 25, 2007 9:43 am    Post subject: Dysfunctional uterine bleeding Practical tips Dysfunctional uterine bleeding is a diagnosis of exclusion: other conditions such as uterine fibroids, endometrial polyps, and systemic diseases must be excluded by appropriate investigations Tranexamic acid and mefenamic acid are among the most effective first line drugs for treating menorrhagia Women needing contraception have a choice of combined oral contraceptive, levonorgestrel releasing intrauterine system, or long acting progestogens Only 2% of endometrial carcinomas occur before age 40. Nulliparity, diabetes, obesity, and polycystic ovary syndrome are risk factors Postmenstrual scans are often useful; the endometrium should be at its thinnest then, and polyps and cystic areas are more noticeable ==================================== Ref: BMJ http://www.bmj.com/cgi/content/short/334/7603/1110?etoc Back to top Nick Raine-Fenning Course Director Joined: 27 May 2006 Posts: 1854 Location: Nottingham Posted: Fri May 25, 2007 3:13 pm    Post subject: Not sure this is still true following the NICE Guideline on HMB. The info (aimed at GPs) mentions this document is 'due' so is out of date. Primary treatment is now the Mirena! Have a read of this link where we have briefly started to discuss the new Guideline. _________________ "Teale Fenning Medical Education" delivering evidence-based, exam-orientated learning since 1997 Back to top EMAK Century Club Joined: 26 Nov 2006 Posts: 572 Posted: Fri May 25, 2007 3:56 pm    Post subject: Quote: Primary treatment is now the Mirena! Really? even before simple medical treatment like mefenamic acid and Cyclocapron ? Actually I recieve this BMJ article just today. Back to top Nick Raine-Fenning Course Director Joined: 27 May 2006 Posts: 1854 Location: Nottingham Posted: Fri May 25, 2007 4:08 pm    Post subject: Yes Read the NICE Guideline. _________________ "Teale Fenning Medical Education" delivering evidence-based, exam-orientated learning since 1997 Back to top cpeedahsa Century Club Joined: 21 Apr 2007 Posts: 921 Posted: Fri May 25, 2007 4:44 pm    Post subject: Quote: Pharmaceutical treatment • If history and investigations indicate that pharmaceutical treatment is appropriate and either hormonal or non-hormonal treatments are acceptable, treatments should be considered in the following order: *levonorgestrel-releasing intrauterine system (LNG-IUS) provided long-term (at least 12-months) use is anticipated *levonorgestreltranexamic acid or non-steroidal anti-inflammatory drugs (NSAIDs) or combined oral contraceptives (COCs) *levonorgestrelnorethisterone (15 mg) daily from days 5 to 26 of the menstrual cycle, or injected long-acting progestogens. • If hormonal treatments are not acceptable to the woman, then either tranexamic acid or NSAIDs can be used. Thi is current stand from NICE on HMB Back to top cpeedahsa Century Club Joined: 21 Apr 2007 Posts: 921 Posted: Fri May 25, 2007 4:47 pm    Post subject: http://www.nice.org.uk/page.aspx?o=CG044 This is the link to the NICE guideline on HMB Back to top cpeedahsa Century Club Joined: 21 Apr 2007 Posts: 921 Posted: Fri May 25, 2007 4:58 pm    Post subject: and also this http://www.nice.org.uk/CG044quickrefguide Back to top EMAK Century Club Joined: 26 Nov 2006 Posts: 572 Posted: Sat May 26, 2007 6:53 am    Post subject: Thanks a lot I read it previuosly and I review it with the forum and with Nick advice. Back to top rpwalavalkar Teale Fenning Administrator Joined: 20 Jul 2006 Posts: 966 Posted: Thu Sep 04, 2008 6:44 am    Post subject: a quick reference list for causes guys, please add or debate causes that you don't agree with --- ovulatory hypothyroidism / hyperthyroidism drug induced/medication side effects (coumadin, ASA, steroids) coagulation disorders -- Idiopathic thrombocytopenia / septicemic thrombocytopenia / immunologic thrombocytopenia hereditary clotting factor abnormalities -- factor VIII deficiency (von Willibrand's disease) factor XI deficiency (Rosenthal's syndrome) factor V deficiency (Owren's disease) factor VII deficiency factor X deficiency (Stuart factor deficiency) prothrombin deficiency and dysfibrinogenemia liver cirrhosis hepatitis trauma/foreign bodies infection severe vaginal infection (trichomonas, bacterial vaginitis, yeast) cervicitis anovulatory with atrophic endometrium contraceptive associated -- DMPA / OCP / POP / Implant increased prolactin -- pituitary prolactinoma hyperprolactinemia other pituitary tumors empty sella syndrome growth hormone excess - acromegally Nelson's syndrome pseudotumor cerebri chronic renal failure/hemodialysis persistant postpartum amenorrhea-galactorrhea chronic systemic disease anovulatory with proliferative/hyperplastic endometrium stress-related polycystic ovarian syndrome hyperandrogenism/insulin resistance adrenogenital syndrome Cushing's syndrome hypothyroidism obesity _________________ Dr Miss. Raj Walavalkar MBBS MRCOG TealeFenning Administrator SR O&G Wessex Region Back to top Display posts from previous: All Posts1 Day7 Days2 Weeks1 Month3 Months6 Months1 Year Oldest FirstNewest First         TEALE FENNING Forum Index -> Key Facts in O&G All times are GMT Page 1 of 1   Jump to: Select a forum Announcements----------------Forum AnnouncementsExam InformationCourse Announcements Examinations----------------MRCOG Part 1: EMCQsMRCOG Part 2: MCQ & Past Paper questionsMRCOG Part 2: EMQs - Extended Matching QuestionsMRCOG Part 2: Short Answer EssaysMRCOG Part 2: Objective Structured Clinical Examination - the OSCEDRCOG: the Diploma ExaminationMFFP: Membership of the Faculty of Family Planning and Reproductive Health Care of the RCOGPLAB: The Professional and Linguistic Assessment Board test General Discussion----------------Open ForumRCOG News & UpdatesThe Study Buddy SchemeKey Facts in O&GGuidelines & ProtocolsRecommended ReadingUseful WebsitesThe Market PlaceHow things work in the UKHow do you say that? Teale Fenning Courses----------------Our UK CoursesOur Overseas CoursesOur Correspondence CourseCourse AdministrationCourse FeedbackAccommodationOther Courses Training & Career Development----------------Basic Speciality Training in O&GSubspeciality Training & Special Skills ModulesAcademic TrainingResearch & AuditThe Curriculum Vitae or CVInterview SkillsMedical EducationPublication & Presentation SkillsTraining Courses, Conferences, & MeetingsThe Job MarketClinical Attachments  You cannot post new topics in this forum You cannot reply to topics in this forum You cannot edit your posts in this forum You cannot delete your posts in this forum You cannot vote in polls in this forum Powered by phpBB © 2001, 2005 phpBB Group