abnormal uterine bleeding Flashcards
What is the average length of menses
3-5 days
What is the normal range of cycle length
21-35 days
What is the average blood loss during menstruation
30mL (can be up to 80mL)
What is primary amenorrhea
lack of primary sex characteristics without a period
age 14 w/o onset of puberty
age 16 w/o menses
What is secondary amenorrhea
w/ sex characteristics but w/o period
Absence of menses for 3 menstrual cycles
What is oligomenorrhea
> 35 days
What is polymenorrhagia
<21 days
What is a sign of androgen insensitivity in regards to amenorrhea
breast development with no pubic/axillary hair
What is
What is the most common cause of secondary amenorrhea
pregnancy
What is Asherman’s syndrome
intrauterine adhesions or PCOS leading to secondary amenorrhea (normal estrogen present)
what is metrorrhagia
uterine bleeding at irregular intervals, esp between expected menstrual periods
What is menometrorrhagia
excessive uterine bleeding both at expected time of menses and at irregular intervals
what is the cause of mid-cycle spotting
Spotting just before ovulation from a decline in estrogen
What is the primary concern with post-menopausal bleeding
malignancy
when is AUB most common
At the beginning and end of reproductive years
What is the most common cause of AUB
ovulatory dysfunction (anovulation)
What is the primary concern with AUB
endometrial cancer
what is the most common gynecological malignancy
endometrial cancer
what put someone at an increased risk for endometrial cancer
obesity
DM
infertility
tamoxifen
>35 years
nulliparity
What is the treatment for endometrial cancer
Total hysterectomy
bilateral salpingo-oophorectomy
*reoccurance tx w/ high dose progestins
what is an anovulatory cycle
corpus luteum does not form
What is ovulatory AUB
progesterone secretion is prolonged
What is the most common cause of anovulatory AUB
PCOS
How does ovulatory AUB present clinically
Excessive bleeding during regular menstrual cycles
How does anovulatory AUB present
unpredictable times and patterns
no accompanied by cyclic changes in basal body temp
What are structural causes of AUB
fibroids
polyps
adenomyosis
What are non-structural causes of AUB
coagulopathy
ovulatory dysfunction
malignancy
What are the main considerations for AUB
- Pregnancy
- Iatrogenic
- systemic disease
- Genital tract infection
When is a TVUS done for workup of AUB
- risk for endometrial cancer
- Age>35
- Bleeding despite empiric hormone therapy
- pelvic organs difficult to exmine
- suspected ovarian / uterine abnormalities
with is the AUB diagnosis if al clinically indicated tests are normal
AUB due to ovulatory dysfunction
what is a saline infused sonohysterography
5-10mL sterile saline in the endometrial cavity to enhance diagnostic power of TVUS
What is hysteroscopy
Scope into the uterus
*generally done with guided biopsy
When is an MRI done for AUB
Planning surgery
best for adenomyosis
what is the most common pelvic tumor in women
uterine leiomyoma
What ethnicity is at higher risk of uterine fibroids
African american
when in life do fibroids usually present
middle/later reproductive years
If a woman has fibroids, what are they at an increased risk for
endometrial cancer
What is the most common presenting symptoms for uterine fibroids
bleeding
What is the first imaging choice for uterine fibroids
TVUS
What is the only real cure for fibroids
hysterectomy
What is adenomyosis
extension of endometrial glands into uterine musculature
What is the definitive therapy for adenomyosis
hysterectomy
What is the typical presentation of adenomyosis
middle aged
parous
severe dysmenorrhea / menorrhagia
enlarged globular uterus
What is the first like treatment for endometriosis
NSAIDs + OCP
How do you diagnose a dysfunctional uterine bleed
Diagnosis of exclusion
What is the most common cause of DUB
Ovulation failure shortly after menarche or during perimenopause
What occurs in anovulatory DUB
estrogen is continually secreted but egg never ripens in follicle
What is an endometrial biopsy used for
r/o hyperplasia / cancer
What is the treatment for endometrial hyperplasia in postmenopausal women
D&C with strong consideration for hysterectomy
What is the treatment for endometrial hyperplasia in premenopausal women
Medroxyprogesterone acetate PO QD 3-6 months
*if resolved -> cyclic admin each month for 10-14 days
What is the first like treatment for AUB
Hormone therapy if contraception is wanted or pt. is premenopausal
What ist he most common hormone therapy for AUB
oral contraceptives
What hormone therapy is preferred if pregnancy is desired
clomiphene
What is the most common cause of AUB
Ovulatory dysfunction
What is the main treatment for PMDD
SSRI (prozac)
