How to investigate Uterine Bleeding

Patient History:
Menstrual cycles: regularity, menarche, duration, abnormalities
- establish their idea of normal/abnormal, regular/irregular
- presence of clots, pain, swelling, discharge, postcoital bleeding, dyspareunia, clots, premenstrual cycles
- Family history of 1º relatives - cycles, menarche, regularities.
Use of contraception: type, duration of length, side-effects
Obstetric history: previous/current pregnancies; complications; ante/post-partum haemorrhage; miscarriages/abortions; previous infertility.
Pap-Smears: results/regularity
STD-checks.

Presenting Complaint:
- Pain, Hirsutism, virilism, male secondary characteristics, abdominal bloating, vaginal bleeding, discharge, weight changes, temperature intolerance, galactorrhoea, nausea, vomiting, constipation, signs of blood loss (shock, anaemia), psychological/mental changes

Medical History:
- Coagulation disorders, bleeding disorders, Endocrine disease (Thyroid), Previous cancers, Previous STDs (PID), IBD (Ulcerative Collitis), Liver/Renal disease

Surgical History:
- Hysteroscopy, laparoscopic salpingoscopy, salpingectomy, hysterectomy, caesarian birth.

Medications:
- anticoagulant medication; OCP (Oestrogen/Oestrogen+Progesterone); IUD; HRT (MP/Contraceptive based)

Family History
- Bleeding disorders
- Endocrine disorders
- Previous menstrual history of first degree relatives

Social History
- Smoking, alcohol, drug use; exercise; diet; occupation; relationships (how many partners/current/past)

Physical Examination
- General appearance: pallor (anaemia), signs of endocrine disease
- Thyroid inspection
- Abdominal examination: uterine, masses (faeces, fat, flatulance, fluid, foetus, tumor), pain, colour abnormalities

Vaginal Examination (only used on currently/previously sexually active individuals)
- Cervical swab (infection - cervicitis)
- Pap-smear
- Examination of vagina (masses, colour, abrasions, bleeding, rashes)

Haematology
- FBC, Iron Studies/Anaemic studies, Blood glucose - normocytic (blood loss anaemia);
- Coagulation studies (INR/PTT)
Biochemistry
- Serum ferritin
- LFT/RFT
Hormones
- Pituitary Hormones (TFTs, Prolactin, LH/P (Ovulation), FSH(PMP/MP), Oestrogen (PMP,MP), testosterone (PCOS)
- Serum b-hCG (pregnancy/ levels indicative of intra/extra-uterine pregnancy)

Pelvic US (if not virgin - Transvaginally and transabdominally)
- Visualisation of polyps, fibroids, uterine bleeding, adenomyosis
CT/MRI
Hysteroscope
- Saline-infusion sonohysteroscopy - use of saline infusion to fill uterine cavity and show any filling abnormalities
Endometrial Biopsy
- Dilatation and Curettage

wizzle

I'm tired, exhausted and feel like all the salmon and tuna i've been eating recently is no longer giving me energy and brain food like all the ads say. Damn omega 3.

In fact, I think I'd find (if I was awake to notice) that all it was really doing for me was giving tuna-smelling wee. No, not infection wee, but literally tuna (possibly with sun-dried tomato flavouring). It seems that stuff goes literally RIGHT through you.

I've almost finished my first run-through of studying. That's my aim by 10pm tonight, when I leave uni and head home for a nice big nap.

Today is a sad day for me and I really just feel like lying at home and watching Bones and not thinking about what happened a year ago.

Tomorrow I'm driving back to Brisbane and buying flowers at the Markets for my mum (who's birthday it is).

I hate the reproductive system. And I hate palm cards. And the chips I had for lunch have made me sleepy. Drat.

a week off...

As usual, I pick up this blog in a similar fashion to how I left it - stressed, late at night and procrastinating from either sleeping or studying. There are probably three important things I should do throughout swat vac, all of which you would expect to come pretty easily, but are in fact easy to not do:

1. Studying
2. Sleeping
3. Eating

The first one, I'm pretty good at, but I tend to get pretty easily distracted at home and usually have to spend most of study week locked in a tutorial room at uni to avoid being distracted by my housemates who enjoy wandering into my room and having half-hour chats. I also have to quit facebook and MSN, or risk being distracted there as well.

The second one, is something that I have no problem doing but can't ever seem to do it at the right times. Don't get me wrong - there's no insomnia on this front - it's just, when I'm studying I always want to sleep and when I'm going to bed I always find something else to do. Like right now, it's 12.20am and I should be fast asleep - but I'm writing this blog.

The third one, well that's the procrastinating tool of geniuses. See, one has to eat, so if one really wants to procrastinate but appear to not be, they just go out and cook an elaborate meal under the guise of 'starvation'.

Tomorrow i'm heading up to the uni at 8am and studying there till 10pm. God I can't wait for this week and a half to be over.

Music I'm enjoying currently:
Friendly Fires
One Silver Astronaut
Sia
Frou Frou/Imogen Heap
Phoenix.