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Women's Health > Abnormal Uterine Bleeding > Flashcards

Abnormal Uterine Bleeding Flashcards

1
Q

what is the frequency and duration of normal bleeding?

A

frequency: q 28-35 days
duration: 3-5 days

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2
Q

prolonged/excessive bleeding at regular intervals

A

abnormal bleeding (menorrhagia)

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3
Q

menstrual bleeding occurring at intervals of every 21 days or less

A

polymenorrhea

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4
Q

irregular menstrual bleeding or bleeding between periods

A

metorrhagia

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5
Q

bleeding occurring less frequently than every 35 days

A

oligomenorrhea

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6
Q

what are the 4 structural causes of abnormal uterine bleeding?

A

PALM

Polyp
Adenomyosis
Leiomyomata (fibroids)
Malignancy and hyperplasia

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7
Q

what are 3 ways to assess polyps?

A

pelvis ultrasound
saline infused sonohysterogram
hysteroscopy

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8
Q

how are fibroids categorized?

A

by location

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9
Q

what causes abnormal uterine bleeding in a woman older than 45 with a history of unopposed estrogen?

A

malignancy / hyperplasia

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10
Q

what are the 5 nonstructural causes of abnormal uterine bleeding?

A

COEIN

Coagulopathy
Ovulatory dysfunction
Endometrial
Iatrogenic
Not yet classified

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11
Q

what is a positive screen for underlying bleeding disorders?

A

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

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12
Q

what is the most common cause of abnormal uterine bleeding?

A

ovulatory

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13
Q

what is the mechanism of ovulatory AUB? (3)

A

abnormal PG synthesis and receptor upregulation

increased local fibrinolytic activity

increased tissue plasminogen activator activity

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14
Q

what is the most common cause of anovulatory AUB?

A

obesity +/- PCOS

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15
Q

endometrium that develops under these conditions is fragile, vascular and lacks stromal support

A

anovulatory AUB

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16
Q

what are the 6 causes of anovulation?

A

adolescence
perimenopause
lactation
pregnancy
hyperandrogenism (PCOS)
hypothalamic dysfunction

17
Q

phase that has a marked increase in tissue levels of prostaglandin

A

luteal phase

18
Q

what is the mechanism for anovulatory bleeding? (4)

A

proliferative endometrium outgrows blood supply

continuous estrogenic stimulation

no regular slough down to level of basalis

alterations in endometrial prostaglandins

19
Q

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?

A

AUB

20
Q

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?

A

beta hCG (pregnancy)

21
Q

what 4 labs should be done to evaluate a patient for AUB?

A

pregnancy test
prolactin
CBC
TSH

22
Q

what diagnostic should be done for AUB?

A

pelvic ultrasound

23
Q

what are the 4 treatment goals in AUB?

A

stop bleeding
prevent recurrence of bleeding
avoid morbidity (anemia)
improve QOL

24
Q

what are 4 medical therapies used for ovulatory AUB?

A

Provera
contraceptives (progesterone)
NSAIDs
tranexamic acid (lysteda)

25
Q

what is a procedure used for ovulatory AUB?

A

levonorgestrel containing IUD

26
Q

what are 3 conservative treatment options for fibroids?

A

OCPs
radiofrequency ablation
uterine artery embolization

27
Q

what are 3 definitive treatments for fibroids?

A

hysteroscopic resection
myomectomy
hysterectomy

28
Q

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?

A

OCPs
cyclic/continuous Provera

Women's Health (20 decks)

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