#136 Managment of Abnormal Uterine Bleeding Associated with Ovulatory Dysfunction Flashcards
What is the bleeding pattern most commonly seen in AUB-O?
Heavy, irregular uterine bleeding
Why does ovulatory dysfunction lead to AUB?
Effects of chronic unopposed estrogen on the endometrium
What are physiologic causes of anovulation?
Adolescence, perimenopause, lactation, pregnancy
What are pathologic causes of anovulation?
Hyperandrogenic anovulation (eg, PCOS, CAH, androgen producing tumors); hypothalamic dysfunction (eg, 2/2 anorexia); hyperprolactinemia; thyroid disease; primary pituitary disease; premature ovarian failure; iatrogenic (eg, 2/2 radiation or chemo); medications
What is the median age of menarche?
12.43 years
What is the typical cycle range in young females?
21-45 days
What is the typical endometrium cycle during menstrual cycle?
Proliferation, secretory changes, shedding, repair
Describe the endometrium that develops in the milieu of unopposed estrogen.
Fragile, vascular, and lacking sufficient stromal support. As one area of bleeding begins to heal, another begins to slough = erratic bleeding patterns
Do patients with AUB-O experience cyclic breast discomfort?
typically no
Do patient with AUB-O experience cyclic increased mucoid vaginal discharge?
Typically no
Do patient with AUB-O experience premenstrual cramping and bloating?
Typically no
Cycles varying in length by more than ____ days from one cycle to another are likely anovulatory.
10 days
What are recommended assessments for AUB?
Thorough history and physical exam. Pregnancy test, sensitive beta hcg (exclude trophoblastic disease), TSH, prolactin level, EMB for women with risk factors for hyperplasia/malignancy, SIS, hysteroscopy, TVUS
How long after menarche are most menstrual cycles 21-34 days long?
By third year after menarche. 60-80% cycles 21-34d.
What is most common etiology of AUB in 13-18yo?
Anovulation d/t immaturity of H-P-O axis
What is most common cause of AUB-O in 19-39yo?
PCOS
What is most common cause of AUB in 40yo to menopause?
Largely related to normal menopausal transition. Need to rule out malignancy and hyperplasia.
What is mean age of menopause in developed countries?
51.4yo
How does smoking affect timing of menopause?
Begins 1.74yrs earlier
What is the average duration of menopausal transition in North America?
4 years
What is the incidence of endometrial cancer in women younger than 20yo?
0.2 per 100,000 women
When should you evaluate endometrium of pts 13-18yo with AUB?
Medical treatment failed and thorough investigation of all other potential causes and co-morbid disorders
What are risk factors for endometrial cancer in women >40yo
Nulliparity, hypertension, BMI > 30, irregular menstruation, family history, tamoxifen use, lynch syndrome
What is the incidence of endometrial cancer among women aged 40-50?
13.6-24 cases per 100,000 women-years
What is the incidence of endometrial cancer in women aged 70-74 years?
87.3 per 100,000
Is AUB-O typically treated medically or surgically?
Medically
True or false: Combined hormonal contraceptives can combat potential underlying coagulopathies?
True. Can increase levels of factor VIII and von Willebrand factor
What are potential post endometrial ablation complications?
Asherman syndrom, synechiae, cervical stenosis, contracture of the endometrium, strictures, endometrial distortion, delay in detection of endometrial cancer
How much of endometrium is sampled by EMB?
4% (0-12%)
What is sensitivity of EMB for detecting endometrial cancer?
83%
What is the likelihood of endometrial cancer diagnosis after a negative hysteroscopy?
0.4-0.5%
When is the endometrium the thinnest in menstrual cycle?
Between days 4-6 of the menstrual cycle
What is the thickness of the endometrium during the proliferative phase?
4-8mm
What is the endometrial thickness during the secretory phase?
8-14mm
What is the sensitivity of SIS to evaluate the uterus and endometrium for pathology?
96-100%
What is the negative predictive value of SIS for evaluating the uterus and endometrium for pathology?
94-100%
