Abnormal Uterine Bleeding

Question 1

Normal menstrual bleeding lasts an average of how long?

Answer 1

5 days (range 2-7 days)

Question 2

What is the mean blood loss per cycle?

Answer 2

40 ml

Question 3

What is defined as blood loss during a menstrual cycle greater than 80ml?

Answer 3

menorrhagia

Question 4

What is known as bleeding between periods?

Answer 4

metrorrhagia

Question 5

What is bleeding that occurs more often that every 21 days?

Answer 5

Polymenorrhea

Question 6

What is bleeding that occurs less frequently than every 35 days?

Answer 6

Oligomenorrhea

Question 7

Abnormal uterine bleeding was previously referred to as what?

Answer 7

Dysfunctional Uterine Bleeding (DUB)

Question 8

Etiologies of abnormal bleeding are structural in nature and are organized with PALM-COEIN, which is what?

Answer 8

1. Polyp
2. Adenomyosis
3. Leiomyoma
4. Malignancy (and hyperplasia)
5. Coagulopathy
6. Ovulatory dysfunction (most common anovulation)
7. Endometrial (commonly hyperplasia)
8. Iatrogenic
9. Non yet classified

Question 9

In adolescents, abnormal uterine bleeding (AUB) is usually the result of what?

Answer 9

Anovulation (not yet ovulating)

Question 10

Once regular menses is established in women, what is the most common cause of abnormal uterine bleeding?

Answer 10

Ovulatory dysfunction (AUB-O)

Question 11

Women aged 19-39 with the following conditions often result in what?

1. pregnancy
2. structural lesions
3. anovulatory cycles
4. use of hormonal contraceptives
5. endometrial hyperplasia

Answer 11

AUB

Question 12

A history of the duration and amount of flow, associated pain, and relationship to the LMP, presence of blood clots or the degree of inconvenience caused by the bleeding serves as useful indicators for the diagnosis of what?

Answer 12

AUB

Question 13

Recent systemic infections and other significant physical or emotional stressors such as thyroid disease or weight change can be indicators for what?

Answer 13

AUB

Question 14

A history of use of medications like warfarin, heparin, or exogenous hormones can cause what?

Answer 14

AUB

Question 15

The physical exam for AUB is used to evaluate for what?

Answer 15

1. Excessive weight and or PCOS
2. thyroid disease
3. insulin resistance
4. bleeding disorders

Question 16

These are all findings that may be associated with what?

1. Rule out vulvar, vaginal, and cervical lesions
2. pregnancy
3. uterine myomas
4. adnexal masses
5. adenomyosis
6. infection

Answer 16

AUB

Question 17

These are all labs that should be drawn for what?

1. CBC
2. HCG
3. TFT
4. Coagulation studies
   a. those with heavy bleeding
5. Gonorrhea and Chlamydia tests
6. Pap smear
7. Endometrial sampling

Answer 17

AUB

Question 18

What imaging is warranted for AUB?

Answer 18

1. Transvaginal ultrasound

2. Sonohysterography or hysteroscopy

Question 19

True or False

All patients with abnormal uterine bleeding should be referred to OB-GYN

Answer 19

True

Question 20

Treatment of premenopausal patients with AUB treatment depends of what?

Answer 20

Etiology

Question 21

AUB secondary to certain causes such as what may require definitive treatment?

Answer 21

1. submucosal myomas
2. infection
3. early abortions
4. thrombophilias
5. pelvic neoplasm

Question 22

Which form of AUB is treated hormonally with progestin to oppose estrogen and normal doses of NSAIDS can reduce the amount of bleeding?

Answer 22

AUB-O

Question 23

Is postmenopausal bleeding cancer until proven otherwise?

Answer 23

Yes, bleeding of any amount 6 months or more following cessation of menstrual cycle

Question 24

What are the most common cause of postmenopausal bleeding?

Answer 24

1. endometrial atrophy
2. endometrial proliferation or hypertrophy
3. endometrial or cervical cancer