abnormal uterine bleeding

Question 1

What is the average length of menses

Answer 1

3-5 days

Question 2

What is the normal range of cycle length

Answer 2

21-35 days

Question 3

What is the average blood loss during menstruation

Answer 3

30mL (can be up to 80mL)

Question 4

What is primary amenorrhea

Answer 4

lack of primary sex characteristics without a period

age 14 w/o onset of puberty
age 16 w/o menses

Question 5

What is secondary amenorrhea

Answer 5

w/ sex characteristics but w/o period

Absence of menses for 3 menstrual cycles

Question 6

What is oligomenorrhea

Answer 6

> 35 days

Question 7

What is polymenorrhagia

Answer 7

<21 days

Question 8

What is a sign of androgen insensitivity in regards to amenorrhea

Answer 8

breast development with no pubic/axillary hair

Question 9

What is

Question 10

What is the most common cause of secondary amenorrhea

Answer 10

pregnancy

Question 11

What is Asherman’s syndrome

Answer 11

intrauterine adhesions or PCOS leading to secondary amenorrhea (normal estrogen present)

Question 12

what is metrorrhagia

Answer 12

uterine bleeding at irregular intervals, esp between expected menstrual periods

Question 13

What is menometrorrhagia

Answer 13

excessive uterine bleeding both at expected time of menses and at irregular intervals

Question 14

what is the cause of mid-cycle spotting

Answer 14

Spotting just before ovulation from a decline in estrogen

Question 15

What is the primary concern with post-menopausal bleeding

Answer 15

malignancy

Question 16

when is AUB most common

Answer 16

At the beginning and end of reproductive years

Question 17

What is the most common cause of AUB

Answer 17

ovulatory dysfunction (anovulation)

Question 18

What is the primary concern with AUB

Answer 18

endometrial cancer

Question 19

what is the most common gynecological malignancy

Answer 19

endometrial cancer

Question 20

what put someone at an increased risk for endometrial cancer

Answer 20

obesity
DM
infertility
tamoxifen
>35 years
nulliparity

Question 21

What is the treatment for endometrial cancer

Answer 21

Total hysterectomy
bilateral salpingo-oophorectomy

*reoccurance tx w/ high dose progestins

Question 22

what is an anovulatory cycle

Answer 22

corpus luteum does not form

Question 23

What is ovulatory AUB

Answer 23

progesterone secretion is prolonged

Question 24

What is the most common cause of anovulatory AUB

Answer 24

PCOS

Question 25

How does ovulatory AUB present clinically

Answer 25

Excessive bleeding during regular menstrual cycles

Question 26

How does anovulatory AUB present

Answer 26

unpredictable times and patterns no accompanied by cyclic changes in basal body temp

Question 27

What are structural causes of AUB

Answer 27

fibroids polyps adenomyosis

Question 28

What are non-structural causes of AUB

Answer 28

coagulopathy ovulatory dysfunction malignancy

Question 29

What are the main considerations for AUB

Answer 29

1. Pregnancy 2. Iatrogenic 3. systemic disease 4. Genital tract infection

Question 30

When is a TVUS done for workup of AUB

Answer 30

- risk for endometrial cancer - Age>35 - Bleeding despite empiric hormone therapy - pelvic organs difficult to exmine - suspected ovarian / uterine abnormalities

Question 31

with is the AUB diagnosis if al clinically indicated tests are normal

Answer 31

AUB due to ovulatory dysfunction

Question 32

what is a saline infused sonohysterography

Answer 32

5-10mL sterile saline in the endometrial cavity to enhance diagnostic power of TVUS

Question 33

What is hysteroscopy

Answer 33

Scope into the uterus *generally done with guided biopsy

Question 34

When is an MRI done for AUB

Answer 34

Planning surgery best for adenomyosis

Question 35

what is the most common pelvic tumor in women

Answer 35

uterine leiomyoma

Question 36

What ethnicity is at higher risk of uterine fibroids

Answer 36

African american

Question 37

when in life do fibroids usually present

Answer 37

middle/later reproductive years

Question 38

If a woman has fibroids, what are they at an increased risk for

Answer 38

endometrial cancer

Question 39

What is the most common presenting symptoms for uterine fibroids

Answer 39

bleeding

Question 40

What is the first imaging choice for uterine fibroids

Answer 40

TVUS

Question 41

What is the only real cure for fibroids

Answer 41

hysterectomy

Question 42

What is adenomyosis

Answer 42

extension of endometrial glands into uterine musculature

Question 43

What is the definitive therapy for adenomyosis

Answer 43

hysterectomy

Question 44

What is the typical presentation of adenomyosis

Answer 44

middle aged parous severe dysmenorrhea / menorrhagia enlarged globular uterus

Question 45

What is the first like treatment for endometriosis

Answer 45

NSAIDs + OCP

Question 46

How do you diagnose a dysfunctional uterine bleed

Answer 46

Diagnosis of exclusion

Question 47

What is the most common cause of DUB

Answer 47

Ovulation failure shortly after menarche or during perimenopause

Question 48

What occurs in anovulatory DUB

Answer 48

estrogen is continually secreted but egg never ripens in follicle

Question 49

What is an endometrial biopsy used for

Answer 49

r/o hyperplasia / cancer

Question 50

What is the treatment for endometrial hyperplasia in postmenopausal women

Answer 50

D&C with strong consideration for hysterectomy

Question 51

What is the treatment for endometrial hyperplasia in premenopausal women

Answer 51

Medroxyprogesterone acetate PO QD 3-6 months *if resolved -> cyclic admin each month for 10-14 days

Question 52

What is the first like treatment for AUB

Answer 52

Hormone therapy if contraception is wanted or pt. is premenopausal

Question 53

What ist he most common hormone therapy for AUB

Answer 53

oral contraceptives

Question 54

What hormone therapy is preferred if pregnancy is desired

Answer 54

clomiphene

Question 55

What is the most common cause of AUB

Answer 55

Ovulatory dysfunction

Question 56

What is the main treatment for PMDD

Answer 56

SSRI (prozac)