Abnormal uterine bleeding Flashcards
The follicular phase represents what days of the menstrual cycle?
Day 1 - 14
The luteal phase represents what days of the menstrual cycle?
Day 14 - 28
What is the dominant hormone during the follicular phase?
Estrogen
The follicular phase corresponds to what phase of endometrium?
Proliferative
What is the dominant hormone during the luteal phase?
Progesterone
The luteal phase corresponds to what phase of endometrium?
Secretory
Menorrhagia is defined as____.
Bleeding > 80 cc or more, bleeding lasting > 7 days
Dysfunctional uterine bleeding is defined as ____.
Abnormal uterine bleeding due to hormonal irregularity
Metrorrhagia is defined as ______.
bleeding at irregular intervals or between periods
What are the two new terms to describe abnormal uterine bleeding?
Heavy menstrual bleeding, Inter-menstrual bleeding
What happens to the length of cycles in the perimenopausal period?
Increased length of cycle
What studies should be ordered when evaluating a patient with heavy menstrual periods and a suspected bleeding disorder?
CBC, PT, PTT
What is the most common inherited bleeding disorder?
Von Willebrands Disease
What percent of women with menorrhagia have Von Willebrand disease?
5 - 15%
What is the genetic inheritance patter of Von Willebrand Disease?
Autosomal Dominant
VW factor is a protein necessary for _____.
Platelet Adhesion
what are the 4 basic tests to order to evaluate for abnormal uterine bleeding?
hCG, CBC, TVUS, Day 20 progesterone
an EMB achieves an adequate sample of endometrium in what percent of postmenopausal women?
84%
an EMB achieves an adequate sample of endometrium in what percent of pre or perimenopausal women?
90%
In what percentage of postmenopausal women does an EMB detect cancer?
99.6%
What is the detection rate of atypical hyperplasia using an EMB?
81%
What percentage of blind D&C procedures missed over 1/2 of the endometrial cavity?
60%
An endometrial stripe < 4 mm has a ____ negative predictive value for endometrial cancer.
> 99%
True or false: Transvaginal US is highly accurate at detecting intracavitary lesions in reproductive age women?
False
What imaging modality should be used when trying to evaluate for an intracavitary lesion in s premenopausal woman?
sonohysterography
What is the most accurate way to diagnose an endometrial polyp?
Hysteroscopy
What type of medical treatment is the gold standard for PCOS?
OCPs
What treatment should you consider in a patient with PMB associated with endometrial atrophy?
Estrogen
NSAIDS decrease menstrual blood loss by what percen?
20 - 40%
What is first line treatment for adolescents with heavy painful menstrual periods?
NSAIDS
Levonorgesterel IUD decreases menstrual blood loss by what percent?
75- 95%
When should you use IV estrogen for heavy menstrual bleeding?
For profuse, acute bleeding
What is the dose of IV estrogen used for acute heavy vaginal bleeding?
25mg q 4 for up to 24 hrs
What is the dose of PO estrogen used for acute heavy bleeding?
10 - 20 mg/day divided into 4 doses
What percentage of patients will undergo hysterectomy within 4 years of endometrial ablation?
25%
