❑ Menstrual History- cycle, when menarche, when menopause.

Laboratory Investigation
Polyp
❑ The nature of bleeding; amount, type of pads, either soaked, frequency changing pads, flooding Full Blood Count
❑ Related symptoms • Hb Anemia
Adenomyosis
❑ intermenstrual bleeding • Urinary pregnancy test In pre-menopausal woman to rule out
Leiomyoma pregnancy
❑ Vaginal discharge
Coagulation Profile Considered in woman who have had HMB since
❑ Weight changes, skin changes, fatigue, mood dso (hypothyroid) Malignancy menarche/family history coagulation dso
❑ Dysmenorrhea and/or pressure symptoms TFT Considered in woman who have sign &
Coagulopathy
symptoms of thyroid disease
❑ Dyspareunia
Differential diagnosis
❑ Anemic symptoms Ovulatory dysfunction Imaging

❑ Subfertility Hysteroscopy or ultrasound as the first-line investigation

Endometrial • Hysteroscopy is diagnostic and therapeutic.
❑ Blood disorders (easy bruising/mucosal bleeding) • Endometrial biopsy during hysteroscopy
❑ Urinary and bowel symptoms History Iatrogenic Others: MRI if indicated
❑ Constitutional symptoms Not-yet classified
❑ Medication History
❑ COCP/HRT use
❑ Anti-coagulants Heavy Menstrual Bleeding (menorrhagia)
Defined as bleeding in excess of 80ml per menstrual cycle when measure Treatment
❑ Past Surgical History
objectively Pharmacological Non-hormonal
❑ Previous uterine surgery
❑ Family History • NSAIDS
Hormonal • Tranexamic Acid
❑ Family History of blood disorder Non-
pharmacological • LNG-IUS
❑ Social/Psychosocial History Complications • COCP
❑ Affect of symptoms towards quality of life • Norethisterone
Surgical • Injectables
❑ Other factors that may affect treatment options • GnRH agonist (pre-op)
Due to bleeding Due to treatment
❑ If she wants to get pregnant afterwards.
Hysterectomy Endometrial ablation
General Examination:
• Severe anemia • Dilatation& curettage :
• Obese/cahexic Uterine perforation,
• Hypotension
• Signs of anemia, thyroid mass, signs of Physical examination Asherman Syndrome Myomectomy
PCOS/ hyperandrogenism Dilatation &
• Vital signs; tachycardia/bradycardia/normal • Endoemterial ablation: Risk curettage
Ovarian mass Pelvic mass
Located at peripheral and pouch of Located at central of abnormal placentation in Urine artery
douglas subsequent preganancy embolisation
Move horizontal and vertical Move horizontal
Abdominal examination Consistency – soft (cyst form) Consistenscy – firm • Others: hemorrhages,
I: Scar, Distension # if hard/solid = malignancy infections
P: Tenderness, Mass
On bimanual examination; On bimanual examination;
P: Dullness - presence of adnexal mass - If move the mass towards xiphersternum,
A: Bruit the mass move. Thus, mass originate from
uterus.
Bimanual : have to know diff uterine and
Presence of ascites
ovary origin
and Speculum examination