021315 abnormal uterine bleeding

Question 1

indication for more than half of all hysterectomies performed in US

Answer 1

abnormal uterine bleeding

Question 2

polymenorrhea

Answer 2

frequent menstruation with bleeding intervals shorter than 21 days

Question 3

menorrhagia

Answer 3

excessive menstrual bleeding (flow or duration). implies regular ovulatory cycles

Question 4

metrorrhagia

Answer 4

irregular menstruation intervals

Question 5

menometrorrhagia

Answer 5

irregular menstruation intervals w excessive flow and/or duration

Question 6

oligomenorrhea

Answer 6

menstruation fewer than 9x/year (average cycle over 35 days)

Question 7

hypomenorrhea

Answer 7

very light or short duration menstruation

Question 8

uterine causes of abnormal uterine bleeding

Answer 8

• 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)

Question 9

leiomyoma

Answer 9

uterine fibroids

Question 10

leiomyomas are associated w

Answer 10

menorrhagia/menometrorrhagia
intermenstrual spotting
pelvic pain
mass symptoms-depend on location (urinary pressure, constipation, flank pain)

Question 11

endometrial polyps and leiomyomas are hormonally sensitive: true or false

Answer 11

true

Question 12

endometrial polyp

Answer 12

fleshy outgrowths of endometrium

Question 13

adenomyosis

Answer 13

benign invasion of endometrium into the myometrium
can cause menorrhagia and dysmenorrhea
clinically: enlarged, tender uterus

Question 14

anovulation is common when

Answer 14

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

Question 15

endometrial atrophy

Answer 15

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

Question 16

abnormal uterine bleeding unrelated to uterine pathology

Answer 16

• anovulatory cycle bleeding due to extremes of reproductive age(one of the most common)
• endometrial atrophy

Question 17

tx for abnormal uterine bleeding

Answer 17

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

Question 18

endometriosis

Answer 18

-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

Question 19

rationale behind endometriosis tx

Answer 19

hormonal suppression to minimize stimulation of endometriosis tissue

decrease inflam and prostaglandins (NSAIDs)