Scientific Society Symposium
The causes of Abnormal Bleeding are summarised in the PALM-COEIN classification. The commonest causes tend to be structural problems such as uterine fibroids and polyps whereas non-structural causes are often of unknown aetiology or associated with medical problems which aree much less common. The 1st line investigation following routine history taking and examination is the performing of an ultrasound scan. This is non-invasive and can easily be performed trans vaginally in a majority of women. It provides good imaging of the pelvic organs and structural abnormalities within the uterus can be identified. In a woman under 40 years with heavy, regular menses, further investigation may not be required. However, if there is irregular bleeding then an endometrial biopsy is needed to check that endometrial cancer is absent. This is a very rare condition in young women particularly in the absence of irregular bleeding, although it is commoner in certain high risk groups such as those on tamoxifen, who are obese or who had polycystic ovarian disease in the past. Endometrial biopsy is straightforward following the development of devices such as the pipelle system. Other similar ones are available depending on the country. Hysteroscopy should be undertaken if it will influence management. It is useful for those with structural disease, either polyps or fibroids, so the potential for hysteroscopic surgery can be assessed. It should also be undertaken in the absence of a good quality scan. It is uncomfortable but usually little more than that although complications can occur on rare occasions. Further imaging maybe required for those with fibroids to identify the position, size and vascularity more clearly.