Abnormal Uterine Bleeding Flashcards
what is the frequency and duration of normal bleeding?
frequency: q 28-35 days
duration: 3-5 days
prolonged/excessive bleeding at regular intervals
abnormal bleeding (menorrhagia)
menstrual bleeding occurring at intervals of every 21 days or less
polymenorrhea
irregular menstrual bleeding or bleeding between periods
metorrhagia
bleeding occurring less frequently than every 35 days
oligomenorrhea
what are the 4 structural causes of abnormal uterine bleeding?
PALM
Polyp
Adenomyosis
Leiomyomata (fibroids)
Malignancy and hyperplasia
what are 3 ways to assess polyps?
pelvis ultrasound
saline infused sonohysterogram
hysteroscopy
how are fibroids categorized?
by location
what causes abnormal uterine bleeding in a woman older than 45 with a history of unopposed estrogen?
malignancy / hyperplasia
what are the 5 nonstructural causes of abnormal uterine bleeding?
COEIN
Coagulopathy
Ovulatory dysfunction
Endometrial
Iatrogenic
Not yet classified
what is a positive screen for underlying bleeding disorders?
heavy menstrual bleeding since menarche
+
ONE:
* postpartum hemorrhage
* surgery related bleeding
* bleeding associated with dental procedure
OR TWO:
* bruising or epistaxis 1-2 x/month
* frequent gum bleeding
* fam hx of bleeding
what is the most common cause of abnormal uterine bleeding?
ovulatory
what is the mechanism of ovulatory AUB? (3)
abnormal PG synthesis and receptor upregulation
increased local fibrinolytic activity
increased tissue plasminogen activator activity
what is the most common cause of anovulatory AUB?
obesity +/- PCOS
endometrium that develops under these conditions is fragile, vascular and lacks stromal support
anovulatory AUB
what are the 6 causes of anovulation?
adolescence
perimenopause
lactation
pregnancy
hyperandrogenism (PCOS)
hypothalamic dysfunction
phase that has a marked increase in tissue levels of prostaglandin
luteal phase
what is the mechanism for anovulatory bleeding? (4)
proliferative endometrium outgrows blood supply
continuous estrogenic stimulation
no regular slough down to level of basalis
alterations in endometrial prostaglandins
a 44 yr old who’s had 3 pregnancies states her cycles have been irregular for the last 2 years. She bleeds 14/30 days of the month and amount varies from spotting to needing pads. She has accidents and bleeds through protection, is feeling frustrated with life, tired, and fatigued. what is the clinical problem?
AUB
a 44 yr old who’s had 3 pregnancies states her cycles have been irregular for the last 2 years. She bleeds 14/30 days of the month and amount varies from spotting to needing pads. She has accidents and bleeds through protection, is feeling frustrated with life, tired, and fatigued. what is the first lab test we should obtain?
beta hCG (pregnancy)
what 4 labs should be done to evaluate a patient for AUB?
pregnancy test
prolactin
CBC
TSH
what diagnostic should be done for AUB?
pelvic ultrasound
what are the 4 treatment goals in AUB?
stop bleeding
prevent recurrence of bleeding
avoid morbidity (anemia)
improve QOL
what are 4 medical therapies used for ovulatory AUB?
Provera
contraceptives (progesterone)
NSAIDs
tranexamic acid (lysteda)
what is a procedure used for ovulatory AUB?
levonorgestrel containing IUD
what are 3 conservative treatment options for fibroids?
OCPs
radiofrequency ablation
uterine artery embolization
what are 3 definitive treatments for fibroids?
hysteroscopic resection
myomectomy
hysterectomy
Mrs. Jones presents with abnormal bleeding, has a normal TSH, prolactin, CBC, and is not pregnant. Her endometrial biopsy and transvaginal US shows normal anatomy. what is her best first line therapy? 2nd line?
OCPs
cyclic/continuous Provera
