abnormal uterine bleeding

Question 1

what is “abnormal bleeding”

Answer 1

Between periods
After sex
“Spotting” at any point of the menstrual cycle
Heavier bleeding than normal
Longer bleeding than normal
Bleeding after menopause

Question 2

dysmenorrhea

Answer 2

Painful menstruation
Cramping/labor like pain
Constant lower abdominal pain (may radiate to back or thigh)

Question 3

primary dysmenorrhea

Answer 3

Onset within 6 months of first period
Unremarkable pelvic exam
Pain resolves in 48-72 hours

Question 4

secondary dysmenorrhea

Answer 4

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

Question 5

pathophys of dysmennorrhea

Answer 5

buildup of fatty acids in cell membranes, then released
PGs and leukotrieneces released in uterus
inflammatory response causes symptoms

Question 6

risk factors for dysmenorrhea

Answer 6

under 20 years old
Weight loss attempts
Depression / anxiety
Heavy menses
Nulliparity
Smoking

Question 7

nonpharm treatment for dysmenorrhea

Answer 7

Heating pad
Exercise
Nutritional supplementation (omega-3 fatty acids; vitamin B)

Question 8

pharmacologic treatment for dysmenorrhea

Answer 8

NSAIDs
Oral contraceptives
Other hormonal contraceptive methods
Androgen (danazol)
Gonadotropin releasing hormone antagonists (leuprolide)

Question 9

danazole for dysmenorrhea

Answer 9

100-200 mg BID

Question 10

leuprolide acetate for dysmenorrhea

Answer 10

3.75 mg IM monthly

Question 11

NSAIDs for dysmenorrhea

Answer 11

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

Question 12

oral contraceptives for dysmenorrhea

Answer 12

1 daily

Question 13

amenorrhea

Answer 13

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

Question 14

pathophysiology of amenorrhea

Answer 14

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

Question 15

treatment of amenorrhea

Answer 15

depends on cause

rule out pregnancy!!!!!!

Question 16

oligomenorrhea

Answer 16

Menstrual cycle over 35 days
Causes: Anovulation, Thyroid disease, Prolactinoma, Perimenopause, Medications
Treatment: Target underlying cause, Hormonal contraception

Question 17

polymenorrhea

Answer 17

Menstrual cycle uder 21 days
Causes: Anovulation, Perimenopause, Anatomic, STIs
Treatment: Target underlying cause, Hormonal contraception

Question 18

menorrhagia

Answer 18

Heavy menstrual bleeding over 80 mL
Causes: Hormonal imbalance, Infection, Fibroids, Coagulopathy
Treatment: Iron supplementation, NSAIDs, Hormonal contraceptive, Target underlying cause

Question 19

acute menorrhagia treatment

Answer 19

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

Question 20

metrorrhagia

Answer 20

Bleeding between periods
Causes: Hormone imbalance, Fibroids, polyps, endometriosis, Medications, IUDs, Infections
Treatment: Target underlying cause, Hormonal contraceptive

Question 21

general abnormal uterine bleeding treatment

Answer 21

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!