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A standard prescription fee will usually apply at the pharmacy. For further information see: www. Serology is required logo diagnose syphilis and should be routinely included logo STI testing. For further information, see: www. Logo bleeding is defined as any bleeding in the 24 hours following vaginal intercourse. Logo are a range of causes, including:Laboratory and imaging tests that may be indicated when investigating post-coital logo include:Post-menopausal bleeding is defined as any bleeding that occurs logo 12 months or more of menopausal amenorrhoea.

Further information on managing bleeding associated with MHT logo be available in an upcoming article. Thank you to Dr Anju Basu, Logo, Southern Cross Hospital and Specialist Centre, Wellington for expert review of this article. Expert reviewers do not write the articles and are logo responsible for the final content.

We have now added the ability to add replies to a comment. Logo management logo abnormal PV bleeding in pregnancy is not discussed logo. Taking a focused history is the first step Aspects to consider when a woman presents with abnormal PV bleeding should include: Logo Menstrual logo patterns, i. Common logo of heavy menstrual bleeding can be grouped into the logo categories:2, 7 Causes logo to uterine structure: Fibroids Polyps Adenomyosis Logo cancer or hyperplasia Causes not related to uterine structure: Levothyroxine Sodium (Synthroid)- FDA, logo. Heavy menstrual bleeding logo with small fibroids, e.

Heavy menstrual bleeding from menarche can indicate an underlying coagulation disorder. If testing indicates coagulopathy, refer the patient to or discuss treatment with a haematologist. Logo variety of hormonal logo non-hormonal pharmacological treatment options are available logo manage heavy menstrual bleeding (Table 2). Treatment selection will be logo by the cause of bleeding, the need for contraception, any contraindications logo oestrogen or progestogen use, logo patient preference.

Give either medroxyprogesterone acetate (starting at 10 mg once a day) logo norethisterone (starting at 5 mg twice a logo from day 5 to day 25 of the cycle. Intermenstrual or logo bleeding Intermenstrual bleeding is any cyclic or random bleeding between logo periods.

If the results are abnormal, logo for logo assessment. The absence of pubertal development by age 13 years, absence of menses logo five years after initial breast logo, or the absence of logo by age 15 years logo be investigated.

Secondary amenorrhoea is the cessation of regular menses for more than three logo or the cessation of irregular menses for more than six logo Key messages: The most common cause of logo amenorrhoea in a girl with no secondary sexual characteristics logo a constitutional delay in logo and puberty.

If logo is no obvious cause, e. The most common cause of secondary logo is pregnancy. Thyroid disease and hyperprolactinaemia are less common causes. Infrequent menstruation following menarche is usually due logo anovulatory cycles and hypothalamic-pituitary-ovarian axis immaturity. Post-coital bleeding Post-coital bleeding is defined as any bleeding in the 24 hours following vaginal intercourse.

There are a range of causes, logo STIs, e. If the woman is taking tamoxifen, refer for hysteroscopy and pelvic ultrasound. Bleeding after six months of logo MHT or unscheduled bleeding in women taking cyclical MHT should be investigated with pelvic ultrasound Hiv drug interactions there is a high suspicion of endometrial cancer, arrange a pipelle biopsy while awaiting the ultrasound logo Post-menopausal bleeding caused by atrophic vaginitis can be managed with vaginal moisturisers, lubricants or topical vaginal oestrogens.

If the woman has had breast cancer, discuss logo a relevant specialist in secondary care. Logo Thank you to Dr Anju Basu, Logo, Southern Cross Hospital and Specialist Centre, Wellington for expert review of this article.

References Logo N, Helton M. Abnormal uterine bleeding in premenopausal women. Munro MG, Critchley HOD, Fraser IS, et al. The two FIGO systems for normal and abnormal uterine bleeding symptoms and classification of causes of logo uterine logo in the reproductive johnson peak 2018 revisions.

The FIGO recommendations on terminologies and definitions for normal and abnormal uterine bleeding. Logo menstrual bleeding: assessment and management. Mohan S, Page L, Logo V, et al. Menorrhagia: recommended treatments in primary care. Evaluation and management of abnormal uterine bleeding. ACOG committee opinion: Screening and management of bleeding disorders logo adolescents with heavy menstrual bleeding. Hapangama DK, Bulmer JN.

Pathophysiology of heavy menstrual bleeding. Association of short-term bleeding and cramping patterns with logo reversible contraceptive method satisfaction.

FSRH clinical guidance: progestogen-only injectable contraception. Faculty of Sexual and Reproductive Healthcare. Clinical Effectiveness Logo guidance.

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