Abnormal Uterine Bleeding

Question 1

4 medical options for treatment of acute abnormal uterine bleeding with dose

Answer 1

Estrogen: 25mg IV q4-6 hr
COCs: 35mcgs ethinyl estrogen PO 3x/day x7days
Medroxyprogesterone acetate: 20mg PO 3x/day x7days
Tranexamic acid: 1.3g PO TID x 5days, or 10mg/kg IV (max 600mg/dose) q8 hr

Question 2

Indications for surgical management

Answer 2

VS changes
Severity of bleeding
Contraindications to medical management
Lack of response to medical management

Question 3

What is the pathophysiology of bleeding due to anovulation?

Answer 3

No corpus luteum develops>no secretion of progesterone by ovary>continued endometrial proliferation, no progesterone wwithdrawal therefore no shedding and bleeding.
Unopposed estrogen on endometrium> fragile, vascular, decreased structure> irregular, non cyclic bleeding

Question 4

4 causes of physiologic anovulation

Answer 4

Adolescence- immaturity of hypothalamic-pituitary-gonadal axis>lack of necessary feedback
Perimenopause- oocyte depletion>abnormal follicular development>anovulatory cycles
Lactation- increased prolactin> negative feedback on hypothalamus
Pregnancy

Question 5

Recommended initial workup for AUB

Answer 5

pregnancy testing
quantitative bHCG for recently pregnant pt
TSH
Prolactin (repeat fasting if elevated)
EMB for pt with high risk of malignancy, hyperplasia
Imaging for suspected anatomic abnormality