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Gynaecology > Abnormal Uterine Bleeding > Flashcards

Abnormal Uterine Bleeding Flashcards

1
Q

What is abnormal uterine bleeding?

A

Acute AUB: spontaneous and severe <6 months
Chronic AUB: >6 months
Abnormality in regularity, volume, frequency and duration of bleeding

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2
Q

What is the normal amount of blood loss during menstruation?

A

35ml with 90% of women having blood loss less than 80ml

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3
Q

What is the definition of acute uterine bleeding?

A
  1. 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
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4
Q

What is chronic AUB?

A

Bleeding from the uterine corpus that is abnormal in duration, volume, and frequency in the past 6 months

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5
Q

What is intermenstrual bleeding?

A

It is bleeding that occurs between clearly defined cyclic and predictable menses
Previously known as metrorrhagia

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6
Q

Describe polyps?

A

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
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7
Q

What is adenomyosis?

A

It is the presence of endometrial tissue in the myometrium

-these women usually present with symptoms of dysmenorrhea and heavy menstrual bleeding

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8
Q

How do we diagnose adenomyosis?

A

With ultrasound and MRI

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9
Q

What are the ultrasound features of adenomyosis?

A
  1. Globular /asymmetric uterus unrelated to leimyomata
  2. Diffuse heterogeneous myometrial echopgenicity including striations and an indistinct endometrial junction
  3. Anechoioc lacunae and/or cysts
  4. Focal abnormal myometrial echo texture, indistinct borders
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10
Q

What is the triad of leiomyoma?

A
  1. Pain
  2. Pelvic mass
  3. Infertility
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11
Q

When does leimyomoas peak?

A

35-45 years

The growth starts to decrease after menopause

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12
Q

What are the sites that leiomyomas grow?

A
  1. Submuscosal
  2. Intra-mural
  3. Subserosal
  4. Pedunculated
  5. Cervical
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13
Q

What is the definition of a leiomyoma?

A

Benign myometrial tumours

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14
Q

What is the classification of leimyomas?

A
  1. Primary -determines whether the fibroids are present or absent on ultrasound
  2. Secondary -determines whether they are submuscous and affect the endometrial cavity
  3. Tertiary-this classification pinpoints the location of the fibroid
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15
Q

Which malignancy is most common with Abnormal Uterine Bleeding?

A
  1. Endometrial carcinoma

2. Others: cervical, ovarian, gestational trophoblastic neoplasia

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16
Q

What are the non-structural/hormonal causes of AUB?

A
  1. Coagulopathy
  2. Ovulatory dysfunction
  3. Endometrial-endometriosis
  4. Iatrogenic
  5. Not yet classified
17
Q

What is the most common cause of coagulopathy problems in patients with AUB?

A

Von-willebrand disease-which causes abnormal platelet aggregation that leads to increased mesntrual blood loss

18
Q

What questions can we ask in history that will point to us thinking about coagulopathy causes of the AUB?

A
  1. Medication-heparin, warfarin
  2. Whether their menstrual periods are heavy
  3. Do they have bleeding gums, do they have epistaxis, bruising?
19
Q

What tests can we do to test for Coagulation disorders?

A
  1. Testing for von willebrand factor

2. Ristocetin factor

20
Q

What causes ovulatory dysfunction?

A
  • 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
21
Q

What are some of the things that can cause ovulatory disorders?

A
  1. Obesity
  2. Stress
  3. Rapid weight loss
  4. Endocrine issues-PCOS, hyperprolactinaemia, hypothyroidism
22
Q

What is the primary cause of endometrial contributors to AUB?

A
  1. Endometriosis
23
Q

What is the approach to endometriosis?

A
  1. Medically- NSAID, oestrogen-progesterone and oestrogen

2. Surgically- laparoscopy or laparotomy and total abdominal hysterectomy

24
Q

What is the iatrogenic causes of AUB?

A
  1. LLETZ
  2. Evacuation
  3. Cone biopsy
  4. Ashermans syndrome
  5. IUCD
25
Q

What is Ashermans syndrome?

A

It is adhesions and fibrosis of the endometrium,after a procedure or intervention like dilatation and curettage

26
Q

What special investigations would we do in these patients?

A
  1. Cervical cystology-papsmear
  2. Bloods: FBC and HB , platelet count
  3. Tranvagimnal and abdominal ultrasound
  4. Saline infusion sonography
  5. Hysteroscopy
  6. Pipeline for endometrial sampling
  7. Laparoscopy
  8. Endocrine investigations-hypothyroidism, hyperprolactinaemia, PCOS
27
Q

What are the side effects of trance a mic acid?

A

Tinnitus, nausea, dizziness, rashes and abdominal cramps

28
Q

What is the medical management of patients with AUB?

A
  1. Tranexamic acid which prevents the activation of plasminogen
  2. NSAIDS-Inhibits prostaglandin synthesis
  3. Combined oral contraceptive pills
  4. Progesterone
  5. Danazol
  6. Gonadotropin releasing hormone analogues
29
Q

In adolescent years what is the most likely cause of Abnormal uterine bleeding?

A

Anovulation

30
Q

In women above 20 years what is the most likely cause of the AUB?

A

Pathological causes

-

31
Q

In a perimenopausal woman(older woman) what are the most likely causes of the AUB?

A
  1. Malignancy in about 50% of the cases

Gynaecology (18 decks)

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