Abnormal Uterine Bleeding Flashcards
What is the difference between primary and secondary amenorhea?
primary - failure of menarche by age 16
secondary - absence of menstruation for 6 mos in a woman who has previously had menses
What are the three general etiologies of amenorrhea?
anatomic - usually primary
ovarian failure (hypergonadotropic hypogonadism)
chronic anovulation - usually secondary
What are the anatomic causes of amenorrhea?
imperforate hymen, transverse vaginal septum, cervical stenosis, Asherman syndrome, mullerian agenesis
What are the ovarian failure (hyper hypo) causes of amenorrhea?
radiation, chemo, advanced oocyte atresia from X ch defects, surgical removal, premature ovarian failure, menopause
What are the chronic anovulation causes of amenorrhea?
with estrogen: PCOS, prolactin excess, thyroid abnormality, ovarian tumors
with estrogen absent (hypo hypo): hypothalamic functional disorders (eating disorders), inherited H/P abnormalities or lesions
What are indications for evaluation of amenorrhea?
pt and family concerned
no breast dev by age 14
any sexual ambiguity present
What is menorrhagia?
cyclic menstrual bleeding, excessive in duration (>7 days) or amount (>80ml)
What is oligomenorrhia?
bleeding or light spotting that occurs in intervals longer than 35 days
What is metorrhagia?
bleeding that occurs at irregular intervals
What is menometorrhagia?
excessive and prolonged bleeding episodes at irregular intervals
What is the PALM-COEIN system for AUB classification in reproductive age women?
Polyp Adenomyosis Leiomyoma (submucosa or other) Malignancy and hyperplasia Coagulopathy Ovulatory dysfunction Endometrial Iatrogenic Not yet classified PALM is structural, COEIN is nonstructural
When is a pap smear appropriate to order?
can help screen for invasive cervical lesions
pts w abnormal cytologic findings must be evaluated
must useful in diagnosing asymptomatic intraepithelial lesions of cervix
When is it appropriate to order serum beta-HCG?
complications of pregnancy and trophoblastic dz
When is it appropriate to order transvaginal sonogram?
after transabdominal approach - more detail
saline infusion during imaging is helpful in evaluating endometrial lining
When is it appropriate to order an endometrial biopsy?
if no cause found or tissue inadequate for diagnosis, use D&C
When is it appropriate to order a hysteroscopy?
visualization by endoscopy - most direct way to assess endometrium
biopsy can be done at same time
What are the five sources of female genital tract bleeding?
vulva and vagina cervix uterus uterine tubes ovaries
What is Asherman syndrome?
extensive intrauterine scarring (synechiae) that causes amenorrhea
endometrial damage to basal layer
How can uterine leiomyomas be recognized?
enlarged, irregular uterine contour
asymptomatic, or menorrhagia and pelvic pressure
submucosal most likely to cause metorrhagia
How are the presentations of threatened abortion vs. ectopic pregnancy different?
threatened abortion: bleeding/pain at <20 wks gestation w/o cervical dilation
sonography! - gestational sac w/i uterus vs. cystic mass in adnexal area
What is the ddx of postmenopausal bleeding?
atrophy of endometrium –> chronic inflammatory rxn
exogenous hormones
tumors of reproductive tract - cancer til proven otherwise
vaginal atrophy and vaginal/vulvar lesions
(structural problems, endometrial hyperplasia)
What is the ddx for abnormal bleeding in a prepubertal girl?
trauma, foreign body, vaginal tumor, precocious puberty, prolapsed urethra
What is the ddx for abnormal bleeding in an adolescent?
anovulation, pregnancy, bleeding dyscrasias, breakthrough on contraceptives
What is the ddx for abnormal bleeding in reproductive age women?
anovulation, pregnancy, structural, breakthrough on contraceptives, cancer
pathologic causes more common here
What is the ddx of post-coital bleeding?
(cervical cancer), cervical erosion, cervical polyps, cervical or vaginal inf like trichomoniasis
