Abnormal Uterine Bleeding Flashcards
typical blood loss vs heavy blood loss for period
Abnormal Volume: excessive blood loss that interferes with quality of life.
Typical blood loss is 30-40ml vaginal blood loss/cycle. Heavy is >80mL vaginal blood loss. 30% of people with bleeding <80mL think they have heavy bleeding.
Do you need to change your pad/tampon at night?
Do you change your tampon/pad every 1-2 hours?
Have you been told you are anemic?
What are the size of your clots?
*structural causes of AUB results in bleeding that is more likely to be ___/___, and non-structural causes are more likely to result in ___/ __ __- → PALMCOEIN
*structural causes of AUB results in bleeding that is more likely to be regular/cyclical, and non-structural causes are more likely to result in irregular/ non cyclical → PALMCOEIN
PALM-COEIN classification of AUB
Structural = PALM= polyp, adenomyosis, leimyoma, malignancy
non-structural = COEIN = coagulopathy, ovulatory dysfunction, endometrial, iatrogenic
Endometrium growths, occupying large portions of uterine growths
Bleeding after straining or activity. May bleed without reason and cause a prolonged period
polyps
Endometrial glands in the stroma are present in the uterine musculature, causing hypertrophy and globular enlargement of the uterus.
Common cause of heavy and long periods/dysmenorrhea.
adenomyosis
what ethnicity is more affected by meiomyomas aka fibroids?
african descent
Fibroids→ very common. Treatment is not necessary unless there are symptoms.
More common in AFrican women.
Benign growths of the muscle of the uterus. Many do not have symptoms; pressure symptoms based on mass effects, pressure on bladder/rectum/during intercourse.
Can bleed because of increased SA of endometrial cavity. Can also affect the contractility ability of the uterus, making it harder to stop bleeding. Very rarely cause pain unless they degenerate and grow so big that they grow out their blood supply which causes ischemia and thus pain.
leiomyoma
Should suspect ___ for long term dysmenorrhea
malignancy/hyperplasia
Any women over 40 with a change in bleeding patterns should have a work up.
Risk factors (FLIP): Age, nulliparity, HNPCC (hereditary nonpolyposis colon cancer), obesity, PCOS, diabetes, tamoxifen
why may ovulatory dysfunction cause abnormal uterine bleeding?
Estrogen and progesterone may not be made cyclically, which is why they are not ovulating. If there is anovulation, there is a concern for unopposed estrogen (no progesterone to cause a period)
There are a bunch of little follicles that are producing estrogen, but none of them are being selected. There is no dominant follicle to become the corpus luteum and produce progesterone.
Causes continuous growth of the endometrial lining and uterus gets bulky.
Unopposed estrogen can cause cancer.
An immature HPO axis can be seen frequently in teens; stress, weight loss, etc all can contribute.
Must ask about endocrine causes (prolactinomas that may prevent ovulation, thyroid, perimenopause)
note– other causes of abnormal uterine bleeding
- Determine the tests to investigate AUB and the rationale for each test
CBC, Ferritin,
consider : bHCG, TSH, prolactin, FSH/E2, androgens (PCOS), coagulation testing, swabs (STI, cervicitis, esp if they have post coital spotting or intermenstrual bleeding)
FSH/E2 not helpful unless they have hot flashes and you think they may be having premature menopause
Imaging:
Transvaginal US: go for pelvic organs, but if the radiologist suspects a structural abnormality, we can do a saline infusion sonohysterography to distend the uterus, allowing for better visualization.
MRI; not as good
CT; not as good
Endometrial Sampling: to rule out hyperplasia or cancer of the endometrium
- Indications: age >40, failure of medical treatment, significant intermenstrual bleeding, infrequent menses, risk factors for endometrial cancer.
Endometrial Biopsy
- Pros: minimally invasive, generally well tolerated, detects 90% endometrial cancers
- Cons: blind test, might miss a focal lesion
Dilation and Curettage: metal rod to dilate cervix, then use curette to get a biopsy of the endometrium. Still a blind procedure (all by feel)
endometrial biopsy are a mainstay of testing for abnormal uterine bleeding and suspciion of endometrial disorders and cancers. what are the pros and cons?
Endometrial Biopsy
Pros: minimally invasive, generally well tolerated, detects 90% endometrial cancers
Cons: blind test, might miss a focal lesion
nonhormal management for AUB
NSAIDS: COX2 and COX1 expression in the uterus is higher, NSAIDS reduce prostaglandin levels wihch are elevated in women with excessive menstrual bleeding.
Tranexamic acis/cyklokapron
rotterdam criteria for PCOS
