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Mod 4 > Abn Uterine Bleeding > Flashcards

Abn Uterine Bleeding Flashcards

1
Q

What should always be ruled out?

A

Pregnancy

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2
Q

Eval of AUB depends on what?

A

Age and RF of patient

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3
Q

Normal Menstral bleeding

A

Avg of 5 days with a mean loss of 40ml per cycle

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4
Q

Menorrhagia

A

blood loss of >80ml per cycle and often produces anemia

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5
Q

Metrorrhagia

A

Bleeding between periods

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6
Q

Polymenorrhea

A

Bleeding that happens more often than eery 21 days

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7
Q

Oligomenorrhea

A

Bleeding that occurs less frequently than every 35 days

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8
Q

PALM COEIN

A

Polyp, Adenomyosis, Leiomyoma, Malignancy/hyperplasia, Coagulaopathy, Ovulatory dysfunction, Endometrial, iatrogenic, not yet classified

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9
Q

Descriptive terms for bleeding pattern

A

heavy, light, menstrual or intramenstrual

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10
Q

Adolescents with AUB

A

result of persistent anovulation due to immaturity of hypothalamic- pituitary- ovarian axis and represents normal physiology. Once regular menses occurs during adolescence- Ovulatory dysfunction AUB (AUB-O) accounts for most cases.

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11
Q

AUB Woman btw 19-39

A

pregnancy, structural lesions, anovulatory cycles, use of hormonal contraception, or endometrial hyperplasia

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12
Q

Lab studies

A

CBC, Preg test, thyroid studies
Coagulation study should be considered
Vaginal/Urine samples to r/o chlamydia

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13
Q

Diagnostic Imaging

A

Transvaginal US- dx intrauterine/ectopic pregnancy, adnexal/uterine masses, evaluate endometrial thickness
Sonohystergraphy or hysterocopy- endometrial polyps or subserous myomas
MRI- definitively diagnose submucous myomas and adenomyosis

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14
Q

Cervical Biopsy and Endometrial Sampling

A

determines if hyperplasia or carcinoma is present

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15
Q

Endometrial Sampling

A

perform in patients with AUB who are older than 45 or in younger patients with hx of unopposed estrogen exposure or failed management/persistent AUB to identify polyps, endometrial hyperplasia and submucous myomas

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16
Q

Premenopausal + Ovulatory dysfunction AUB
irregular or light bleeding

A

medroxyprogesterone actate 10mg/day or norethindrone acetate 5mg/day, should be given for 10 days, following which withdrawal bleeding can occur, if works can be repeated for several cycles, starting on day 15 of following cycles. Can be reinstitute if amenorrhea or dysfunctional bleeding recurs

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17
Q

Premenopausal + Ovulatory dysfunction AUB
Menorrhagia

A

NSAIDS- Naproxen or mefenamic acid- reduce blood even that associated with a copper IUD

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18
Q

Premenopausal + Ovulatory dysfunction AUB
heavier bleeding

A

taper of any COC with 30-35mcg of estrogen estradiol to control the bleeding,
several regimens- 4x a day for 1-2 days then 2 pills daily through day 5 then one pill a day through day 20, after withdrawal bleeding occurs pills are taken usual dosage for 3 cycles

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19
Q

Premenopausal + Ovulatory dysfunction AUB
Intractable Heavy Bleeding

A

GnHR agonist (depor leuprolide, 3.75mg IM every month) for up to 6 months to create temporary cessation of menstruation by ovarian suppression. require 2-4 weeks to down-regulate the pituitary and stop the bleeding. Will not sop bleeding acutely

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20
Q

Premenopausal + Ovulatory dysfunction AUB
Heavy bleeding requiring hospitalization

A

IV conjugated estrogen 25mg Q4hrx 3-4 doses followed by oral conjugated estrogsten 2.5mg daily or eithunyl estradiol 20mcg orally daily for 3 weeks.

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21
Q

ABN bleeding uncontrolled with hormones

A

hysterocopy with tissues sampling or saline infusion sonohysterography is used to evaluate for structural lesions or neoplasms

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22
Q

Bleeding unresponsive to medical therapy- after all causes have been ruled out

A

endometrial ablation- LNG-IUD- markedly reduces menstrual blood loss- good alternative to other therapies or hysterectomy

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23
Q

When to refer-

A

bleeding not controlled with 1st line medication or expertise required for sx procedure

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24
Q

when to admit

A

bleeding uncontrolled with 1st line or patient is not hemodynamically stable

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25
Anovulatory AUB/DUB
irregular cycle, short cycles with scanty flow or period of amenorrhea
26
Anovulatory AUB/DUB Cause
alteration to hypothalamic- pituitary axis
27
Anovulatory AUB/DUB Patho
corpus luteum not formed- failure of cyclical secretion of progesterone- cont unopposed production of estradiol- stimulates overgrowth of endometrium- endometrium grows thick , outgrown blood supply- necrosis and irregular bleeding
28
Anovulatory AUB/DUB Prevalence
95% of dysfunctional bleeding in adolescents is due to anovulation without ovulation- no progesterone is produced- state of unopposed estrogen- endo thickens- breaks down irregularly- heavy/prolonged bleeding
29
How to take menstrual History all
Age, cycle length, duration of bleeding, perception bleeding, product used, 1st day of last LMP, Dysmennorahea
30
How to take menstrual History Reporing HMB
soaking through tampons, pads in 1hr? passing clots >1inch using double protection flooding or gushing feeling frequent accidents or leaking through dx with anemia
31
Treatment plan of HMB
determined by hemodynamic status and degree of anemia of patient
32
Treatment plan General
HPO takes time to mature after menarche- anovulation for up to 2 years after menarches in approx 82% of females
33
Treatment plan Assessment
hemodynamically stable- no pallor, tachycardia, murmur perform pelvic exam refer
34
Treatment Plan History/Lab
menstrual calendar, assess for anemia and possible clotting DO initial labs- UPT, CBC, PT/PTT, TSH, fibrinogen lvl, iron panel, prolactin, testosterone, 17-hydroxprogesterone, chlamydia
35
Treatment plan General Meds
Iron supplement, NSAIDs, OCPS Not bleeding- cyclic OCP if bleeding- OCP 30/50 Estrongen contraindicated- norethindrone acetate or tranexamic acid
36
AUB Treatment- Article Mild
Duration <3months/Hgh normal Keep calendar, observation, encourage use of antiprostaglandin meds to decrease menorrhagia
37
AUB Treatment- Article Moderate
heavy/frequent menses with mild anemia Cyclinc OCP/Taper method of monipahasic OCPs
38
AUB Treatment- Article Servere
Prolonged Heavy flow with Hgh <9 hgh <7 hospital Hgh 8-10 Tapering OCP
39
Tranexamic ACID
Antifibrinolytic- used to tx heavy menses in women who may not desire to have their fertility negatively affected or may wish to conceive
40
postmenopausal has vaginal bleeding
transvaginal US to measure endometrial thickness <4mm not likely endometrial cancer, >4mm endometrial sampling is needed
41
NSAIDS for AUB
Ibuprofen Flurbiprofen Meclofenamate Sodium Mefenamic acid Naproxen
42
Antifbrinolytics
Aminocaproic acid Tranexmic acid
43
Hormonal devices
IUD, Ring, Patch
44
AUB-O
Abnormal uterine bleeding from ovulatory disorders
45
AUB- E
Abnormal uterine bleeding from Endometrial
46
AUB- L
Abnormal uterine bleeding from leiomyomas
47
DMPA
AUB-E & AUB-o
48
Leuprolide
AUB-L
49
LNG-IUD
AUB-O, AUB-L, AUB- E
50
NSAIDS
AUB-O/L/E
51
Oral Contraceptives
All
52
Oral Progesterone
AUB-E/O
53
Tranexamic Acid
AUB-E/O/L
54
Conjugated Equine estrogen
25mg IV- Q4-6hr for 24 hr
55
COC
Monophasic combined oral contraceptives pills that contain 30-50 mcg of ethuny estradiol Q6-8hr untill cessation of bleeding
56
Medroxypregesterone Acetate
20mg Orally- TID per 7 days
57
Tranexamic acid
1.3g orally or 10mg/kg IV Q8hr for 5 days
58
What must you exclude AUB?
Pregnancy, Anatomical disorders, nonanatomical disorders
59
Anatomical disorders that cause bleeding?
PALM- polyps, adenomyosis, leiomyoma, and malignancy
60
Nonantomical disorders
COEIN- coagulopathies, ovulatory dysfunction, endometrial iatrogenic, not classified.
61
Regular exercise and maintenance of a healthy BMI is recommend because
high BMI increase the risk of ovulatory dysfunction and subsequent heavy or irregular menstrual loss, limit iron deficiency anemia
62
Women suffereing from HMB have?
over activation of the fibrinolytic system during the menstrual phase of their cycle- increase blood loss during endometrial shedding
63
Tranexamic acid
antifibrinolytics- used in women with heavy menstrual bleeding, short half life, 1g PO 3-4x a day during menses. SE- GI, okay for woman trying to conceive or with major SE with hormonal preparations. use with caution in woman with hx of thromboembolism, cuts bleeding in half

Mod 4 (4 decks)

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