#128 Diagnosis of Abnormal Uterine Bleeding in Reproductive-Aged Women Flashcards
How long does the normal menstrual cycle last (time between)
21 to 35 days
What is the definition of heavy menstrual bleeding
Great than 80mL (research), clinically based on patient perception
What is menorrhagia
heavy menstrual bleeding
What is metrorrhagia
Bleeding between periods
What is polymenorrhea
Bleeding that occurs more often than every 21 days
What is oligomenorrhea
Bleeding that occurs less frequently than every 35 days
What percentage of women presenting at any age with HMB will have an underlying bleeding disorder
up to 20%
What herbal remedies can cause AUB?
Ginkgo, ginseng, motherwort
Which patients w/ HMB should be tested for underlying disorder of hemostasis?
-HMB since menarche
- PP hemorrhage
- Surgery-related bleeding
- Bleeding associated with dental work
Two or more of the following:
- bruising 1-2x/mo
- epistaxis 1-2x/mo
- frequent gum bleeding
- FH of bleeding symptoms
What are physical exam findings suggestive of a bleeding disorder?
Petechiae, ecchymoses, skin pallor, swollen joints
What is the name of the test for von Willebrand disease?
von Willebrand-ristocetin cofactor activity, von Willebrand factor antigen, and factor VIII
Is hypothyroidsim or hyperthyroidism associated with AUB?
Both are, but hypothyroidism is more common
What are the imaging modalities used to evaluate AUB?
Primary imaging test TVUS. Then SIS of hysteroscopy to better evaluate uterine cavity. MRI is not a primary imaging modality for AUB.
How many adolescents with AUB who require hospitalization have an underlying coagulopathy?
As many as 19%
What is the sensitivity of TVUS for detecting intracavity pathology?
56%
What percentage of women with AUB have intrauterine abnormalities?
46.6%
When should endometrial tissue sampling be performed in patients with AUB?
Patients with AUB who are older than 45 years, or younger than 45 years with a history of unopposed estrogen exposure, failed medical management, and persistent AUB.
What is the concern of EMB with a focal lesion?
If the cancer occupies less than 50% of the surface area of the endometrial cavity, blind biopsy may miss it
What is the chance of endometrial cancer with a negative EMB?
0.9%
What does persistent bleeding after benign EMB necessitate?
Further work up
What ultrasound findings support a diagnosis of adenomyosis?
Heterogeneous myometrium, myometrial cysts, asymmetric myometrial thickness, and subendometrial echogenic linear striations
How is adenomyosis best visualized?
T2-weighted MRI
Is ultrasound or MRI better at detecting adenomyosis?
MRI is equal to better than ultrasound. MRI performs better with coexisting myomas.
When is treatment for AUB appropriate?
Trial of therapy is appropriate when risk for hyperplasia, neoplasia, or structural abnormalities is low. For those at increased risk, >45, initiation of therapy is appropriate after diagnostic evaluation
