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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
Q

Anovulatory AUB/DUB

A

irregular cycle, short cycles with scanty flow or period of amenorrhea

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26
Q

Anovulatory AUB/DUB
Cause

A

alteration to hypothalamic- pituitary axis

27
Q

Anovulatory AUB/DUB
Patho

A

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
Q

Anovulatory AUB/DUB
Prevalence

A

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
Q

How to take menstrual History
all

A

Age, cycle length, duration of bleeding, perception bleeding, product used, 1st day of last LMP, Dysmennorahea

30
Q

How to take menstrual History
Reporing HMB

A

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
Q

Treatment plan of HMB

A

determined by hemodynamic status and degree of anemia of patient

32
Q

Treatment plan
General

A

HPO takes time to mature after menarche- anovulation for up to 2 years after menarches in approx 82% of females

33
Q

Treatment plan
Assessment

A

hemodynamically stable- no pallor, tachycardia, murmur
perform pelvic exam
refer

34
Q

Treatment Plan
History/Lab

A

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
Q

Treatment plan
General Meds

A

Iron supplement, NSAIDs, OCPS
Not bleeding- cyclic OCP
if bleeding- OCP 30/50
Estrongen contraindicated- norethindrone acetate or tranexamic acid

36
Q

AUB Treatment- Article
Mild

A

Duration <3months/Hgh normal
Keep calendar, observation, encourage use of antiprostaglandin meds to decrease menorrhagia

37
Q

AUB Treatment- Article
Moderate

A

heavy/frequent menses with mild anemia
Cyclinc OCP/Taper method of monipahasic OCPs

38
Q

AUB Treatment- Article
Servere

A

Prolonged Heavy flow with Hgh <9
hgh <7 hospital
Hgh 8-10 Tapering OCP

39
Q

Tranexamic ACID

A

Antifibrinolytic- used to tx heavy menses in women who may not desire to have their fertility negatively affected or may wish to conceive

40
Q

postmenopausal has vaginal bleeding

A

transvaginal US to measure endometrial thickness <4mm not likely endometrial cancer, >4mm endometrial sampling is needed

41
Q

NSAIDS for AUB

A

Ibuprofen
Flurbiprofen
Meclofenamate Sodium
Mefenamic acid
Naproxen

42
Q

Antifbrinolytics

A

Aminocaproic acid
Tranexmic acid

43
Q

Hormonal devices

A

IUD, Ring, Patch

44
Q

AUB-O

A

Abnormal uterine bleeding from ovulatory disorders

45
Q

AUB- E

A

Abnormal uterine bleeding from Endometrial

46
Q

AUB- L

A

Abnormal uterine bleeding from leiomyomas

47
Q

DMPA

A

AUB-E & AUB-o

48
Q

Leuprolide

A

AUB-L

49
Q

LNG-IUD

A

AUB-O, AUB-L, AUB- E

50
Q

NSAIDS

A

AUB-O/L/E

51
Q

Oral Contraceptives

A

All

52
Q

Oral Progesterone

A

AUB-E/O

53
Q

Tranexamic Acid

A

AUB-E/O/L

54
Q

Conjugated Equine estrogen

A

25mg IV- Q4-6hr for 24 hr

55
Q

COC

A

Monophasic combined oral contraceptives pills that contain 30-50 mcg of ethuny estradiol Q6-8hr untill cessation of bleeding

56
Q

Medroxypregesterone Acetate

A

20mg Orally- TID per 7 days

57
Q

Tranexamic acid

A

1.3g orally or 10mg/kg IV Q8hr for 5 days

58
Q

What must you exclude AUB?

A

Pregnancy, Anatomical disorders, nonanatomical disorders

59
Q

Anatomical disorders that cause bleeding?

A

PALM- polyps, adenomyosis, leiomyoma, and malignancy

60
Q

Nonantomical disorders

A

COEIN- coagulopathies, ovulatory dysfunction, endometrial iatrogenic, not classified.

61
Q

Regular exercise and maintenance of a healthy BMI is recommend because

A

high BMI increase the risk of ovulatory dysfunction and subsequent heavy or irregular menstrual loss, limit iron deficiency anemia

62
Q

Women suffereing from HMB have?

A

over activation of the fibrinolytic system during the menstrual phase of their cycle- increase blood loss during endometrial shedding

63
Q

Tranexamic acid

A

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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