Abnormal Uterine Bleeding Flashcards
What is abnormal uterine bleeding?
Acute AUB: spontaneous and severe <6 months
Chronic AUB: >6 months
Abnormality in regularity, volume, frequency and duration of bleeding
What is the normal amount of blood loss during menstruation?
35ml with 90% of women having blood loss less than 80ml
What is the definition of acute uterine bleeding?
- An episode of bleeding in a woman of reproductive age who is not pregnant, in which there is sufficient quantity to require immediate intervention to prevent further blood loss
What is chronic AUB?
Bleeding from the uterine corpus that is abnormal in duration, volume, and frequency in the past 6 months
What is intermenstrual bleeding?
It is bleeding that occurs between clearly defined cyclic and predictable menses
Previously known as metrorrhagia
Describe polyps?
These are abnormal protrusions of the endometrium or the cervix
- we diagnose them on ultrasound or hysteroscopy
- histological analysis may be needed to confirm the benign status
What is adenomyosis?
It is the presence of endometrial tissue in the myometrium
-these women usually present with symptoms of dysmenorrhea and heavy menstrual bleeding
How do we diagnose adenomyosis?
With ultrasound and MRI
What are the ultrasound features of adenomyosis?
- Globular /asymmetric uterus unrelated to leimyomata
- Diffuse heterogeneous myometrial echopgenicity including striations and an indistinct endometrial junction
- Anechoioc lacunae and/or cysts
- Focal abnormal myometrial echo texture, indistinct borders
What is the triad of leiomyoma?
- Pain
- Pelvic mass
- Infertility
When does leimyomoas peak?
35-45 years
The growth starts to decrease after menopause
What are the sites that leiomyomas grow?
- Submuscosal
- Intra-mural
- Subserosal
- Pedunculated
- Cervical
What is the definition of a leiomyoma?
Benign myometrial tumours
What is the classification of leimyomas?
- Primary -determines whether the fibroids are present or absent on ultrasound
- Secondary -determines whether they are submuscous and affect the endometrial cavity
- Tertiary-this classification pinpoints the location of the fibroid
Which malignancy is most common with Abnormal Uterine Bleeding?
- Endometrial carcinoma
2. Others: cervical, ovarian, gestational trophoblastic neoplasia
What are the non-structural/hormonal causes of AUB?
- Coagulopathy
- Ovulatory dysfunction
- Endometrial-endometriosis
- Iatrogenic
- Not yet classified
What is the most common cause of coagulopathy problems in patients with AUB?
Von-willebrand disease-which causes abnormal platelet aggregation that leads to increased mesntrual blood loss
What questions can we ask in history that will point to us thinking about coagulopathy causes of the AUB?
- Medication-heparin, warfarin
- Whether their menstrual periods are heavy
- Do they have bleeding gums, do they have epistaxis, bruising?
What tests can we do to test for Coagulation disorders?
- Testing for von willebrand factor
2. Ristocetin factor
What causes ovulatory dysfunction?
- usually at the extremes of the reproductive age
- particularly at menarche or pre-menopausal
- common in PCOS, hyperprolactinaemia and hypothyroidism manifesting secondary as irregular menstruation but due to delayed ovulation
What are some of the things that can cause ovulatory disorders?
- Obesity
- Stress
- Rapid weight loss
- Endocrine issues-PCOS, hyperprolactinaemia, hypothyroidism
What is the primary cause of endometrial contributors to AUB?
- Endometriosis
What is the approach to endometriosis?
- Medically- NSAID, oestrogen-progesterone and oestrogen
2. Surgically- laparoscopy or laparotomy and total abdominal hysterectomy
What is the iatrogenic causes of AUB?
- LLETZ
- Evacuation
- Cone biopsy
- Ashermans syndrome
- IUCD
What is Ashermans syndrome?
It is adhesions and fibrosis of the endometrium,after a procedure or intervention like dilatation and curettage
What special investigations would we do in these patients?
- Cervical cystology-papsmear
- Bloods: FBC and HB , platelet count
- Tranvagimnal and abdominal ultrasound
- Saline infusion sonography
- Hysteroscopy
- Pipeline for endometrial sampling
- Laparoscopy
- Endocrine investigations-hypothyroidism, hyperprolactinaemia, PCOS
What are the side effects of trance a mic acid?
Tinnitus, nausea, dizziness, rashes and abdominal cramps
What is the medical management of patients with AUB?
- Tranexamic acid which prevents the activation of plasminogen
- NSAIDS-Inhibits prostaglandin synthesis
- Combined oral contraceptive pills
- Progesterone
- Danazol
- Gonadotropin releasing hormone analogues
In adolescent years what is the most likely cause of Abnormal uterine bleeding?
Anovulation
In women above 20 years what is the most likely cause of the AUB?
Pathological causes
-
In a perimenopausal woman(older woman) what are the most likely causes of the AUB?
- Malignancy in about 50% of the cases
