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1st Repro > Abnormal Uterine Bleeding > Flashcards

Abnormal Uterine Bleeding Flashcards

1
Q

—frequent menstruation with bleeding intervals shorter than 21 days

A

-Polymenorrhea

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2
Q

—excessive menstrual bleeding, in terms of flow (>80mL) and/or duration (>7 days). This implies regular ovulatory cycles.

A

-Menorrhagia

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3
Q

—irregular menstruation intervals

A

-Metrorrhagia

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4
Q

—irregular menstruation intervals with excessive flow and/or duration

A

-Menometrorrhagia

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5
Q

—menstruation fewer than 9 times per year (i.e., average bleeding intervals >35 days)

A

-Oligomenorrhea

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6
Q

—very light or short duration menstruation

A

-Hypomenorrhea

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7
Q

—uterine bleeding in between apparently ovulatory menses

A

-Intermenstrual bleeding

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8
Q

 Pregnancy – normal pregnancies or abnormal pregnancies

 Infection – endometritis, cervicitis, pelvic inflammatory disease

 Neoplasms- Benign and malignant

 Adenomyosis

A

all conditions that can cause abnormal uterine bleeding

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9
Q

Associated with menorrhagia/menometrogghagia: causing refractory anemia

intermetnral spotting, pelvic pain/dysmenorrhea

Mass symtptoms: urinary pressure/urgency, constipation, flank pain, increased abdominal girth

A

Leiomyoma or uterine fibroids (benign)

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10
Q
  • 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

A

Uterine fibroids

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11
Q

Fibroids have a____ component and are____ responsive

A

genetic

hormonally

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12
Q

Fibroids are Hormonally responsive

• Leiomyomas(a fibroid) have increased amounts of

A

both estrogen and progesterone receptor (ER and PR) messenger ribonucleic acid (mRNA)

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13
Q

What increases and decreases risk for uterine fibroids?

A

Parity decreaes risk of uterine fibroids

Obesity increases risk of fibroids

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14
Q

• Both myometrial processes (adenomyosis and leiomyomas) and endometrial processes (polyps) can result in

A

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.

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15
Q

Endometrial polyps, endocervical polyps and adenomyosis are all

A

benign neoplasms that can cause abnromal uterine bleeding

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16
Q

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

A

significantly with age.

17
Q

When symptomatic, these polyps usually manifest as intramenstrual or postcoital spotting.

A

Endocervical Polyps- These soft, fleshy growths originate from the mucosal surface of the endocervical canal.

18
Q

• Benign invasion of endometrium into the myometrium

  • Cause menorrhagia and dysmenorrhea
  • Clinically pts have enlarged, tender uterus
A

Adenomyosis

19
Q

Two malignant neoplasms that can cause abnormal uterine bleeding

A
20
Q

• Typically diagnosed with endometrial biopsy or endometrial curettage/hysteroscopy specimen

A

• Endometrial cancer

21
Q

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

A

cyclic exposure to postovulatory progesterone

***Endometrium becomes abnormally thickened and structurally incompetent.

22
Q

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.

A

Anovulation and abnormal uterine bleeding

23
Q

result is asynchronous shedding of portions of the endometrium unaccompanied by vasoconstriction. The bleeding associated with unopposed estrogen exposure is often heavy.

A

anovulation and abonormal bleeding as a result of: unopposed estrogen exposure (w/out progestin)

24
Q

Anovulation and abnormal uterine bleeding : predisposes endometrium to :

A

endometrial hyperplasia and endometrial cancer

*** risk of progression to cancer based upon duration of unopposed estrogen exposure

25
Q

Often described as spotting

Related to hypoestrogenism

A

Endometrial Atrophy

26
Q

What do we need to distiguish endometrial atrophy from?

A

indistinguishable from the earliest symptoms of endometrial cancer and thus must be carefully evaluated in the perimenopausal and postmenopausal woman.

27
Q

Recommended imaging for abnormal uterine bleeding

A
  • Pelvic ultrasound • Hysterosonogram • Pelvic MRI
  • Hysteroscopy
28
Q

What do we see with adenomyosis on ultrasound?

A
29
Q

Recomended tx for abnormal uterine bleeding caused by anovulation

A

restore regular exposure to estrogen adn progesterone:

BC pills work or progesterone only pills to reduce endometrial thickening

30
Q

What medical therapies are options for women to to minimize bleeding from fibroids?

A
  • Oral contraceptive pills
  • GnRH agonists
  • GnRH antagonists
  • Progesterone receptor modulators
  • Aromatase inhibitors
31
Q

Surgical tx recomended for endometiral polpys

A

operative hysteroscopy

32
Q

Recommened surgical tx for uterine fibroids

A

Myomectomy: abdominal, laparascopic, hysteroscopic

33
Q

Endometriosis is the presence of ______and ______outside the endometrial cavity and uterine musculature

  • Can result in adhesions
  • Causes pain and infertility
  • Results in generalized inflammatory state
A

endometrial glands and stroma

34
Q

Consequences of endometroisis

A
  • Can result in adhesions
  • Causes pain and infertility
  • Results in generalized inflammatory state
35
Q

Why would we use OCP, GnRH agonists or aromatse inhibitors to tx Endometriosis?

A

• Hormonal suppression to minimize stimulation of endometriosis tissue

36
Q

What is the reasoning for using NSAIDS to tx endometriosis

A
37
Q

How does endometriosis contribute to infertility?

A
  • Causes adhesions that can distort the normal pelvic anatomy
  • Can result in ovarian cysts
  • Resultant macrophages and cytokines cause an inflammatory state in the pelvis
  • Adversely **affects endometrial receptivity **
38
Q

Why is endometriosis particullary challenging when trying to tx infertility?

A

The best treatments for endometriosis entail suppression of ovulation

It can result in severe adhesions that make surgical correction of anatomy challenging

higher risk of ectopic pregnancy

39
Q
  • Dysmenorrhea
  • Dyspareunia
  • Infertility
A

Endometriosis

1st Repro (16 decks)

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