abnormal uterine bleeding Flashcards
what is “abnormal bleeding”
Between periods After sex “Spotting” at any point of the menstrual cycle Heavier bleeding than normal Longer bleeding than normal Bleeding after menopause
dysmenorrhea
Painful menstruation
Cramping/labor like pain
Constant lower abdominal pain (may radiate to back or thigh)
primary dysmenorrhea
Onset within 6 months of first period
Unremarkable pelvic exam
Pain resolves in 48-72 hours
secondary dysmenorrhea
Onset in 20s-30s after relatively painless cycles Heavy or irregular bleeding Abnormality on pelvic exam Poor response to NSAIDs or OCPs Infertility Vaginal discharge
pathophys of dysmennorrhea
buildup of fatty acids in cell membranes, then released
PGs and leukotrieneces released in uterus
inflammatory response causes symptoms
risk factors for dysmenorrhea
under 20 years old Weight loss attempts Depression / anxiety Heavy menses Nulliparity Smoking
nonpharm treatment for dysmenorrhea
Heating pad
Exercise
Nutritional supplementation (omega-3 fatty acids; vitamin B)
pharmacologic treatment for dysmenorrhea
NSAIDs Oral contraceptives Other hormonal contraceptive methods Androgen (danazol) Gonadotropin releasing hormone antagonists (leuprolide)
danazole for dysmenorrhea
100-200 mg BID
leuprolide acetate for dysmenorrhea
3.75 mg IM monthly
NSAIDs for dysmenorrhea
celecoxib: 400 mg x1 then 200 mg BID diclofenac 50 mg TID ibuprofen 800 mg TID mefenamic acid: 500 mg x1 the n250 mg QID naproxen 500-550 mg BID
oral contraceptives for dysmenorrhea
1 daily
amenorrhea
Absence of menstruation for ≥ 6 months
Primary
-No menses by age 14 in absence of signs of puberty
-No menses by age 16 with other signs of puberty
Secondary
-No menses for 3 months when previously regular
-No menses for 6 months when previously irregular
pathophysiology of amenorrhea
disorders of uterus/outflow tract - asherman’s syndrome, mullerian syndrome, complete androgen resistance
disorders of ovary - turner syndrome, gonadal dysganasis, primary ovarian insufficiency
disorders of anteriour pituitary gland - hyperprolactinemia, cushing syndrome, medications
disorder of hypothalamus/CNS - eating disorder, stress, infection
treatment of amenorrhea
depends on cause
rule out pregnancy!!!!!!
oligomenorrhea
Menstrual cycle over 35 days
Causes: Anovulation, Thyroid disease, Prolactinoma, Perimenopause, Medications
Treatment: Target underlying cause, Hormonal contraception
polymenorrhea
Menstrual cycle uder 21 days
Causes: Anovulation, Perimenopause, Anatomic, STIs
Treatment: Target underlying cause, Hormonal contraception
menorrhagia
Heavy menstrual bleeding over 80 mL
Causes: Hormonal imbalance, Infection, Fibroids, Coagulopathy
Treatment: Iron supplementation, NSAIDs, Hormonal contraceptive, Target underlying cause
acute menorrhagia treatment
Tranexemic acid 1300 mg PO TID x 5 days
Medroxyprogesterone 20 mg PO TID x 1 week
High dose estrogen
-25 mg IV q4 hours until bleeding slows
-Monophasic OC (with 30-35 mcg EE) TID x 1 week
metrorrhagia
Bleeding between periods
Causes: Hormone imbalance, Fibroids, polyps, endometriosis, Medications, IUDs, Infections
Treatment: Target underlying cause, Hormonal contraceptive
general abnormal uterine bleeding treatment
Anovulation -Sign of unopposed estrogen -Need progesterone in some form Anatomic -Fibroid, polyp, adenomyosis -May try conservative treatment with hormones prior to surgery HORMONAL CONTRACEPTIVE!
