Abnormal Uterine Bleeding Flashcards
—frequent menstruation with bleeding intervals shorter than 21 days
-Polymenorrhea
—excessive menstrual bleeding, in terms of flow (>80mL) and/or duration (>7 days). This implies regular ovulatory cycles.
-Menorrhagia
—irregular menstruation intervals
-Metrorrhagia
—irregular menstruation intervals with excessive flow and/or duration
-Menometrorrhagia
—menstruation fewer than 9 times per year (i.e., average bleeding intervals >35 days)
-Oligomenorrhea
—very light or short duration menstruation
-Hypomenorrhea
—uterine bleeding in between apparently ovulatory menses
-Intermenstrual bleeding
Pregnancy – normal pregnancies or abnormal pregnancies
Infection – endometritis, cervicitis, pelvic inflammatory disease
Neoplasms- Benign and malignant
Adenomyosis
all conditions that can cause abnormal uterine bleeding
Associated with menorrhagia/menometrogghagia: causing refractory anemia
intermetnral spotting, pelvic pain/dysmenorrhea
Mass symtptoms: urinary pressure/urgency, constipation, flank pain, increased abdominal girth
Leiomyoma or uterine fibroids (benign)
- Most prevalent during the reproductive years
- Typically regress or become asymptomatic after the onset of
menopause
• Are rarely observed before puberty
• Treatment depends on location and patient’s desires for fertility
Uterine fibroids
Fibroids have a____ component and are____ responsive
genetic
hormonally
Fibroids are Hormonally responsive
• Leiomyomas(a fibroid) have increased amounts of
both estrogen and progesterone receptor (ER and PR) messenger ribonucleic acid (mRNA)
What increases and decreases risk for uterine fibroids?
Parity decreaes risk of uterine fibroids
Obesity increases risk of fibroids
• Both myometrial processes (adenomyosis and leiomyomas) and endometrial processes (polyps) can result in
abnormal uterine bleeding
myometrium acts as reservoir of growth factors or immune cells that act on the endometrium in a paracrine or local endocrine fashion.
Endometrial polyps, endocervical polyps and adenomyosis are all
benign neoplasms that can cause abnromal uterine bleeding
Endometrial Polyps - Endometrial polyps are localized overgrowths of the endometrium that project into the uterine cavity. Although endometrial polyps in premenopausal women are usually benign, the risk of associated endometrial malignancy increases
significantly with age.
When symptomatic, these polyps usually manifest as intramenstrual or postcoital spotting.
Endocervical Polyps- These soft, fleshy growths originate from the mucosal surface of the endocervical canal.
• Benign invasion of endometrium into the myometrium
- Cause menorrhagia and dysmenorrhea
- Clinically pts have enlarged, tender uterus
Adenomyosis
Two malignant neoplasms that can cause abnormal uterine bleeding
• Typically diagnosed with endometrial biopsy or endometrial curettage/hysteroscopy specimen
• Endometrial cancer
Anovulation and abnormal uterine bleeding are common at extremes of reproductive age spectrum and as a result of chronic exposure of the endometrium to estrogen without the benefit of
cyclic exposure to postovulatory progesterone
***Endometrium becomes abnormally thickened and structurally incompetent.
chronic exposure of the endometrium to estrogen without the benefit of cyclic exposure to postovulatory progesterone. In this situation, the endometrium becomes abnormally thickened and structurally incompetent.
Anovulation and abnormal uterine bleeding
result is asynchronous shedding of portions of the endometrium unaccompanied by vasoconstriction. The bleeding associated with unopposed estrogen exposure is often heavy.
anovulation and abonormal bleeding as a result of: unopposed estrogen exposure (w/out progestin)
Anovulation and abnormal uterine bleeding : predisposes endometrium to :
endometrial hyperplasia and endometrial cancer
*** risk of progression to cancer based upon duration of unopposed estrogen exposure
