Abnormal uterine bleeding

Question 1

Abnormal uterine bleeding can have a cause or not have a cause. What is it called when it does not have a cause

Answer 1

Dysfunctional uterine bleeding (DUB)

Question 2

What are causes of abnormal uterine bleeding and what test can you do for each to rule it out. Most common cause is pregnancy so get pregnancy test

Answer 2

1. ) Ectopic pregnancy - get B-HCG level
2. ) Anemia - get CBC
3. ) Cervical cancer - get PAP smear
4. ) Hypothyroidism/hyperprolactinemia - get hormone levels
5. ) Von Willebrand’s disease and factor 11 deficiency - get platelet count and PT/PTT
6. ) Uterine masses/polycistic ovaries - get ultrasound

Question 3

Bleeding can be categorized into heavy bleeding, ovulatory bleeding, and anovulatory bleeding. What are the treatments for each

Answer 3

1. ) Heavy bleeding - IV estrogen, second line D&C
2. ) Ovulatory bleeding - NSAIDs to reduce blood loss, OCP’s as second line
3. ) Anovulatory bleeding - convert proliferative endometrium to secratory endometrium by giving progestins x 10 days to stimulate withdrawal bleeding. Desmopressin may also help increase vWF and factor VIII

Question 4

What is medical management fails, what is the next step in treatment

Answer 4

1. ) D&C
2. ) Hysteroscopy - if polyps are present
3. ) Hysterectomy/endometrial ablation

Question 5

What is the definition of congenital adrenal hyperplasia

Answer 5

Either from 21 hydroxylase or 11-b hydroxylase deficiency, so cannot make cortisol so instead you start making excess testosterone

Question 6

How does 21 hydroxylase deficiency present

Answer 6

Presents in newborn infant female with ambiguous genitilia and life threatening salt wasting

Question 7

What are four hormones that, if elevated, should raise suspicion for certain diseases

Answer 7

• If androgens high - adrenal/ovarian neoplasm
• If testosterone high - ovarian tumor
• If DHEAS high - adrenal source
• If 17-OH progesterone levels high

Question 8

What is the treatment for congenital adrenal hyperplasia

Answer 8

Glucocorticoids - only stops new terminal hair growth, does not resolve hirsutism

Question 9

What is the definition of hirsutism and virilization

Answer 9

1. ) Hirsutism - male hair pattern

2. ) Virilization - Frontal balding, muscularity, clitoromegaly

Question 10

What is the criteria for diagnosis of polycystic ovarian syndrome

Answer 10

Requires two of the following three

1. ) Polycystic ovaries
2. ) Oligo-/anovulation
3. ) Hyperandrogenism symptoms

Question 11

What are two random disease processes that presents with polycistic ovarian syndrome

Answer 11

1. ) Acanthosis nigricans

2. ) Androgenic alopecia

Question 12

What do you see in the lab values of someone with PCOS

Answer 12

LH/FSH is greater than 2 to 1, with elevated testosterone and DHEAS

Question 13

What is the treatment for PCOS

Answer 13

No conceiving: Combination OCPs, progestin, and metformin

Conceiving: Clomiphene and metformin

Question 14

How do you treat the symptoms that are specific to PCOS

Answer 14

1.) Hirsutism: Combination OCPs first line, second line is spironolactone and finasteride

Question 15

What are future complications of PCOS

Answer 15

1. ) Type 2 diabetes
2. ) Miscarriage risk
3. ) Long term risk of breast and endometrial cancer due to unopposed estrogen secretion