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GYN > abnormal bleeding > Flashcards

abnormal bleeding Flashcards

1
Q

Menorrhagia

A

hypermenorrhea): prolonged duration of menses (>7 days) and/or increased amount of bleeding (>80mL) occurring at regular intervals

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2
Q

Hypomenorrhea:

A

unusually scanty menstrual bleeding lasting for less than 2 days; menses occur at regular intervals

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3
Q

Metrorrhagia:

A

uterine bleeding at irregular intervals, particularly between expected menstrual periods

Bleeding between periods

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4
Q

Menometrorrhagia

A

uterine bleeding that is prolonged and completely irregular

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5
Q

Polymenorrhea

A

frequent but regular menstrual cycles (<21 days

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6
Q

Oligomenorhea:

A

regular but prolonged menstrual cycles (>35 days)

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7
Q

Amenorrhea:

A

no menstrual bleeding for at least 3 cycles or 6 months

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8
Q

Postmenopausal bleeding (PMB):

A

uterine bleeding that occurs more than 12 months after the last menstrual period

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9
Q

Postcoital bleeding

A

vaginal bleeding during or after intercourse

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10
Q

Dysmenorrhea

A

painful menses

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11
Q

Anovulatory bleeding:

A

uterine bleeding that is not associated with ovulation

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12
Q

Dysfunctional uterine bleeding (DUB):

A

abnormal uterine bleeding with no demonstrable organic cause; a diagnosis of exclusion

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13
Q
  • Normal menses should be about every
A

every 21-35 days

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14
Q

– Variability in more than______ is considered irregular

A
  • Variability in more than 20 days is considered irregular
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15
Q

 VulvoVaginal causes of bleeding

A 
	Trauma
	Cancer
	Atrophy
	Infection
	Benign growths
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16
Q

 Ectropion can cause what kind of bleeding

A

causes post coital bleeding

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17
Q

 Polyps can cause what kid of bleeding

A

causes post coital bleeding

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18
Q

causes of uterine bleeding

A 
DUB
Leiomyoma; structural abnormalities
ectopic 
ovulatory dysfunction
bleeding disorder
infection 
endometrial cancer
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19
Q

ovarian or adnexal causes of bleeding

A 
salpingitis PID 
ovarian cancer (VERY UNUSUAL)
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20
Q

structural causes

A

i. Polyp, Adenomyosis, Leiomyoma, Malignancy & hyperplasia

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21
Q

bleeding in post menopause

A

uterine ca

22
Q

neonates vaginal bleeding

A

estrogen w/d 30 days

23
Q

precocious puberty

A

early as 8

24
Q

post menopausal causes of bleeding

A

HRT
endometrial CA
atrophy (5 or 6 years post menopause)

25
Q

PALM COING

A

non gravid reproductive
age causes of bleeding

polyp
adenomyosis
leiomyoma
malignancy and hyperplasia

unrelated to structure

coagulopathy
ovulatory dysfunction
endometrial
iatrogenic
not yet classified
26
Q

liver or renal disease

A

can cause these problems as well

27
Q

cervical cytology results that would indicate the need for EMB

A

AGC of the endometrium (high risk)

ACG of all other categories if >35 or have other risk factos’

bleeding in women >40

28
Q

Associated molimenol sx in a pt with irregular bleeding you would think

A

(breast tenderness, cramping, moody, etc) –

suggest ovulatory cause

29
Q

quantitative pregnancy

test

A

allows you to see what is happening over time via hcg

30
Q

45 yo G3P3 female c/o heavy, prolonged menstrual bleeding x 4-6 mos. BTL 5 yrs ago. No meds, NKDA. She is using 8-10 tampons/day for 5-7 days and her cycles are 21-25 days in length. This is increased from baseline of 3-4 tampons/day for 3-5 days and 28-30 day cycles for 20+ years. All pregnancies uncomplicated. No PMH; FH noncontributory.

DDX

A

perimenopause

Polyps
Adenomyosis
Leiyoma
Malignancy

Coagulopathy 
Ovulatory dysfunction
Enodemtium
Iantrogenic
Not yet classified

hypothyroidism

31
Q

adenomyosis

A

Islands ofendometrial tissue within the myometrium (muscular layer of the uterine wall).

32
Q

sxs of adenomyosis

A

Menorrhagia (progressively worsens), dysmenorrhea, infertility.

symmetric
soft
tender

33
Q

physical exam with adenomyosis

A

(uniformly)enlarged”boggyuterus”*

“globular” enlargement.

34
Q

adenomyosis vs endometriosis

A

endometriosis is outside of the uterus

adenomyosis is in the uterine wall

35
Q

endometritis

A

post partum

fever
vaginal discharge

PID more typical in younger women

36
Q

endometrial polyp is associated with

A

mertorrhagia

37
Q

non tender mobile uterus

A

most likely benign fibroids

38
Q

when do you send pts to the ER for anemia

A

hgb <10
or sxs

can also send pt to blood bank

39
Q

MC pelvic tumor and MCC of hevay vaginal bleeding

A

leyomyomas

myomas or fibroids

made from smooth muscle cells

40
Q

DUB dx by

A

ovulatory or anovulatory

41
Q

tx of acute bleed

A

usually avoid medoxyprogesterone (Provera)

micornized progestrone is safer but you can use either

Provera (MPA)20 mg PO QD x10 days or Prometrium 200 mg x 14 days

both of these organize the endometrium

42
Q

Moderate bleeding >3 days:

A

monophasic oral contraceptive BID-TID x 5-7 days

43
Q

extreme bleeding DUB tx

A

inpatient

Conjugated Estrogen (Premarin) 25 mg IV
 Q6H x 4 doses, then progesterone or surgical curettage
44
Q

reoccurent DUB tx

A

OCP one tablet per day for 21 days

better to use IUD

OR intermitten progesterone therapy
Medroxyprogesterone acetate 10mg daily, Day1-10 of each month/cycle

45
Q

Most common cause of DUB in adolescents

A

Anovulatory Cycles

46
Q

Responses to anovulation

A

amenorrhea
estrogen withdrawal bleeding
estrogen breakthrough bleeding: stromal crowding
heavy (menorrhagia) or irregular (metrorrhagia) bleeding

47
Q

tx of DUB in immature HPO axis

A

Progestin therapy 10 days every month or every other until full maturity of the axis provides effective therapy

Low dose OCP’s

Progestin therapy does not interfere with the normal progression to spontaneous ovulatory cycles.

48
Q

Perimenopausal Women DUB needed

A 
Endometrial biopsy (EMB)
Endovaginal ultrasound (endometrial stripe < 5mm)
Saline ultrasound (SIS)
49
Q

TX of DUB in perimeno woman

A

Atrophic vaginitis: Topical estrogen

Endometrial atrophy: due to hypoestrogenism resulting in thinning of surface that is prone to bleeding

Endometrial hyperplasia: continuous bleeding

Progesterone x 3-6 months, then re-biopsy
Tri-cyclic or continuous HRT

50
Q

post coital bleed DDX

A 
Endocervical infection (GC,Chlamydia)
Cervical or vaginal warts
Friable ectropion
Neoplasia (invasive): Vaginal, cervical, endocervical, or endometrial
Endometritis (acute or chronic)
Polyp: Endocervical or endometrial
Vaginal foreign body
Urethral lesion
51
Q

endometrial ablation requires

A

Requires normal EMB
and negative pregnancy test

Not effective if submucosal fibroids

GYN (13 decks)

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