021315 abnormal uterine bleeding Flashcards
indication for more than half of all hysterectomies performed in US
abnormal uterine bleeding
polymenorrhea
frequent menstruation with bleeding intervals shorter than 21 days
menorrhagia
excessive menstrual bleeding (flow or duration). implies regular ovulatory cycles
metrorrhagia
irregular menstruation intervals
menometrorrhagia
irregular menstruation intervals w excessive flow and/or duration
oligomenorrhea
menstruation fewer than 9x/year (average cycle over 35 days)
hypomenorrhea
very light or short duration menstruation
uterine causes of abnormal uterine bleeding
- pregnancy (normal and abnormal pregnancies)
- infection (pelvic inflam dis, cervicitis/endometritis-STDs)
- neoplasm (benign include fibroids and polyps, malignant includes endometrial cancer and cervical cancer)
leiomyoma
uterine fibroids
leiomyomas are associated w
menorrhagia/menometrorrhagia
intermenstrual spotting
pelvic pain
mass symptoms-depend on location (urinary pressure, constipation, flank pain)
endometrial polyps and leiomyomas are hormonally sensitive: true or false
true
endometrial polyp
fleshy outgrowths of endometrium
adenomyosis
benign invasion of endometrium into the myometrium
can cause menorrhagia and dysmenorrhea
clinically: enlarged, tender uterus
anovulation is common when
at extremes of reproductive age spectrum
can cause abnormal uterine bleeding b/c chronic exposure of endometrium to estrogen w/o benefit of cyclic exposure to postovulatory progesterone–endometrium becomes abnormally thick and structurally incompetent. results in asynchronous shedding of portions of endometrium unaccompanied by vasoconstriction. bleeding associated w/ unopposed estrogen exposure is often HEAVY
endometrial atrophy
spotting
related to hypoestrogenism (may see in menopausal pt or hypothalamic amenorrhea)
diff from anovulation bleed
clinically indistinguishable from early endometrial cancer so should be carefully looked at in perimenopausal/postmenopausal women
abnormal uterine bleeding unrelated to uterine pathology
- anovulatory cycle bleeding due to extremes of reproductive age(one of the most common)
- endometrial atrophy
tx for abnormal uterine bleeding
anovulatory: restore regular exposure to estrogen and progesterone
fibroids: attempt to minize bleeding (oral contraceptive pills, GnRH agonists, GnRH antagonists, progesteron receptor modulators, aromatase inhibitors)
surgical tx for polyps and fibroids
endometriosis
-presence of endometrial glands and stroma outside the endometrial cavity and uterine musculature
- causes PAIN (w periods and intercourse) and INFERTILITY
- results in generalized inflam state
- can cause adhesions
rationale behind endometriosis tx
hormonal suppression to minimize stimulation of endometriosis tissue
decrease inflam and prostaglandins (NSAIDs)
