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Women's Health > Abnormal Uterine Bleeding > Flashcards

Abnormal Uterine Bleeding Flashcards

1
Q

What is the normal range of menstrual cycle length?

A

21-35 days

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2
Q

What is the average length of menses?

A

3-5 days; normal variation 2-7 days

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3
Q

What is the average age of menarche in the U.S.?

A

12.4 years

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4
Q

In regards to the menstrual cycle physiology, when does the hypothalamus release gonadotropin releasing hormone (GnRH)?

A

Begins secreting several days before onset of menstraution in a pulsatile manner

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5
Q

What is polymenorrhagia?

A

< 21 days between cycles

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6
Q

What is oligomenorrhea?

A

> 35 days between cycles

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7
Q

What is dysmenorrhea?

A

Pain with menses

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8
Q

In primary amenorrhea, if normal secondary to sexual characteristics what are the common causes?

A
  • Imperfect hymen
  • Transverse vaginal septum
  • Cervical or Mullerian agenesis: absence of vagina and/or uterus
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9
Q

If there is breast development but no pubic or axillary hair leading to primary amenorrhea, what is the likely cause?

A

Androgen insensitivity

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10
Q

In primary amenorrhea, if there is incomplete development of secondary sexual characteristics what are the likely etiologies?

A
  • Hypothalamus or pituitary tumor
  • Hypothyroidism
  • Premature ovarian failure
  • Hyperprolactinemia
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11
Q

Is physiological delay of puberty common in girls?

A

No

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12
Q

What is the most common cause of secondary amenorrhea?

A

Pregnancy

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13
Q

Any bleeding prior to menarche is abnormal, if bleeding is present what is there concern for?

A

Malignancy
Trauma
Sexual abuse
Urinary tract issues

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14
Q

What is the primary concern if there is any post-menopausal bleeding?

A

Malignancy until proven otherwise

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15
Q

What is the epidemiology of abnormal uterine bleeding?

A
  • Common condition affecting 1:4 women
  • Most common beginning and end of reproductive years
  • More prevalent in obese or extremely low BMI
  • 90% of cases are due to ovulatory dysfunction (causing anovulation)
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16
Q

Can uterine bleeding be an emergency?

A

Yes, extreme blood loss

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17
Q

What is the treatment of acute uterine bleeding?

A

Emergency measures: volume replacement with bleeding cessation
- stabilize hemodynamically (IV fluids, blood products)
- Hormonal control (estrogen replacement)
- Gynecology consult

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18
Q

What is the most common gynecological malignancy?

A

Endometrial cancer

19
Q

What is the most common presenting symptom of endometrial cancer?

A

abnormal uterine bleeding

20
Q

What are the risk factors for endometrial cancer?

A
  • Obesity
  • Nulliparity
  • DM
  • Infertility/unopposed estrogen/chronic anovulatory cycles
  • > 35 years old
  • Tamoxifen
21
Q

What is the treatment for endometrial cancer?

A

Total hysterectomy and bilateral salpingo-oophorectomy

22
Q

Why is it so important to obtain medication history and current treatment in abnormal uterine bleeding?

A

Medications can cause ovulatory problems

*medications that are dopamine based most commonly, soy or ginko supplements, SSRI’s, corticosteroids

23
Q

Does a corpus luteum form during an anovulatory cycle?

A

No

24
Q

What are causes of ovulatory AUB?

A

PCOS
Endometriosis

*excessive bleeding during regular menstrual cycles

25
Q

What are the structural causes of abnormal uterine bleeding?

A

Polyp
Adenomysis
Leiomyoma
Malignancy and hyperplasia

26
Q

When working up AUB in women of reproductive age all should receive what test?

A

Urine or blood pregnancy test

27
Q

What are some potential causes of pregnancy related bleeding?

A
  • Threatened abortion
  • Incomplete abortion
  • Missed abortion
  • Ectopic pregnancy
  • Placenta previa
  • Trophoblastic disease
28
Q

If all clinically indicated tests are normal in the work-up of abnormal uterine bleeding what should be the diagnosis?

A

Ovulatory dysfunction

29
Q

What imaging modality can detect most sources in abnormal uterine bleeding?

A

TVUS

30
Q

What is the most common pelvic tumor in women?

A

Uterine leiomyoma (Fibroids)

31
Q

In working-up fibroids, what is the first-line of imaging?

A

TVUS

32
Q

What is the most common presentation of uterine leiomyoma (fibroids)?

A

*Often asymptomatic

  • Bleeding (m/c)
  • Symptoms depend on number, size and location
33
Q

What is the only definitive treatment for fibroids?

A

Hysterectomy

34
Q

What are the medication treatments for fibroids?

A

Hormonal therapies (GnRH agonists, OCPs, IUD)

35
Q

What is the most accurate imaging tool in diagnosing adenomyosis?

A

MRI

36
Q

What is the treatment for adenomyosis?

A
  • D&C, GnRH agonist
  • Definitive treatment is hysterectomy
37
Q

What are the signs and symptoms of endometriosis?

A
  • Dysmenorrhea
  • Dyspareunia
  • Spotting
  • Pelvic pain
38
Q

What is the diagnostic testing for endometriosis?

A
  • TVUS
  • Laparoscopy and biopsy of lesions
39
Q

What is the first-line treatment for endometriosis?

A

NSAIDs and OCP

40
Q

What is dysfunctional uterine bleeding (DUB)?

A

Absence of organic disease or anatomic lesion

*diagnosis of exclusion

41
Q

What is the most common cause of dysfunctional uterine bleeding?

A

Ovulation failure shortly after menarche or during perimenopause

42
Q

What is the treatment for endometrial hyperplasia in postmenopausal women?

A

D&C with strong consideration for hysterectomy

43
Q

Ovulatory dysfunction is the leading cause of AUB, so what is the treatment in pre-menopausal women?

A

*Need to correct hormones

Hormone therapy
- OCP, progestogen, IUD

44
Q

What is premenstrual syndrome (PMS)?

A

Wide range of physical or emotional symptoms usually occuring 5-11 days before monthly menstrual cycle

Women's Health (14 decks)

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