Abnormal Uterine Bleeding Flashcards
AUB Objectives
- Review characteristics of the normal menstrual cycle
- Define Abnormal Uterine Bleeding (AUB)
- Understand the PALM-COINE classification system used for assessment, differential diagnosis, and mngmnt of AUB
- Identify the laboratory/diagnostic tests commonly used in the assessment, differential diagnosis, and mngment of AUB
- Review the assessment, dx, and mngmt of amenorrhea
Normal Uterine Bleeding
- Frequency
- Normal:
- Abnormal
- Absent:
- Infrequent:
- Frequent:
- Duration
- Normal
- __ days or fewer
- Shortest to longest cycle variation __-__ days or fewer
- Abnormal
- Prolonged:
- Shortest to longest cycle variation __-__ days or more
- Normal
- Flow Volume
- Normal
- _____
- _____
- Frequency
- 24-38 days
- No bleeding
- More than 38 days
- Less than 24 days
- 24-38 days
- Duration
- Normal
- 8
- 7-9
- Abnormal
- Prolonged: more than 8 days
- 8-10
- Normal
- Flow Volume
- Normal
- Light
- Heavy
Heavy Menstrual Bleeding (HMB)
Quantitative
- Changing pads/tampons > __ hrs, use of > __ tampons for a single menses, have to change at ____, ____ > 1 inch, an____
Qualitative
- Excessive menstrual los which intereferes with a woman’s?
- >3 hrs, >20, night, clot, anemia
- physical, social, emotional, and/or material quality of life
Normal Bleeding Chart
Variation in cycle duration varies more at what ages ranges? (2)
- *18-25 years < __ d
- 26-41y, < __ d
- 42-45 y, < __
18-25 and 42-45
- 9
- 7
- 9
Intermenstrual Bleeding (IMB) Chart
Bleeding between cyclically regular onset of menses
- N____
- R____
- Cyclic (Predictable) (3)
- None
- Random
- Early, Mid, Late Cycle
Unscheduled Bleeding on Progestin + Estrogen Gonadal Steroids
(birth control pills, rings, patches, or injections)
- Not Applicable =
- None or Present =
- not on gonadal steroid medication
- on gonadal steroid medication
AUB: Chronic
Bleeding changes in _____, _____, ______, or ______ relative to the person’s _____
**> ___ months of excessive duration, volume, frequency, or unpredictability
Ph_____ v. P______ v. Ph______
duration, amount, frequency, regularity, norm
3m**
Physiologic, Pathologic, Pharmacologic
Most Common Cause of AUB
=
PREGNANCY
(or some complication of pregnancy)
***ALWAYS RULE OUT PREGNANCY FIRST!!!***
AUB: PALM-COEIN Classification System
for causes of AUB in the Reproductive years
-
STRUCTURAL
- P
- A
- L
- M
-
NON-STRUCTURAL
- C
- O
- E
- I
- N
- Polyp
- Adenomyosis
- Leiomyoma
- Malignancy and Hyperplasia
- Coagulopathy
- Ovulatory Dysfunction
- Endometrial
- Iatrogenic
- Not otherwise classified
Structural changes: tx usually surgical
AUB: Structural POLYPS
**CC: Bleeding with s___, ___ing, ____ing, _______ bleeding
Bleeding with sex, lifting, straining, intermenstrual bleeding
AUB Structural: ADENOMYOSIS
Where does it occur?
**CC:
**Exam:
In the muscle layer - endometrial implants
Regular, prolonged HMB, painful menses (dysmenorrhea), painful sex (dyspareunia), chronic pevlic pain
Uterus is boggy, globular, tender
CC: PAIN!
AUB: Structural: LEIOMYOMA (Fibroid, Myoma)
=
**CC:
**PE:
Actual growths (not made of endometrial tissue, made of stroma and fibrous tissue)
Can occur at any layer
Regular, prolonged HMB (bulk symptoms: urinary frequency, pain with sex, pelvic pressure) -presses on bladder
Uterus is firm, enlarged, non-tender, irregular, bulky
AUB Structural: MALIGNANCY (and Hyperplasia)
Risk Factors
- Overexposure to endogenous _______
- O_____, ___parity, ___ menopause, ____ menarche, chronic __ovulation, P _ _ _
- _____ Hx/ Genetics
- Medications (1)
- A___/____menopausal
**CC:
- estrogen*
- Obesity, nulliparity, late, early, anovulatin, PCOS
- Family
- Selective Estrogen Receptor Modulate (SERMS)
- Age/Postmenopausal
HMB, prolonged, irregular, IMB or postmenopausal bleeding
AUB Non-Structural: COAGULOPATHY
Clotting Disorders
- 13% of AUB pts
- Adolescents w AUB: 20-30% ___ ______
**Clinical Presentation**
- _ _ _, pro_____, since _____
- PMH: _ _ Hemorrhage, s____ related bleeding, bleeding w ____ work, br_____, n____ bleeds, bleeding g____
- FmH: Bleeding ______
Lab Tests (4)
Management (1)
- Von Willibrands
- HMB, prolonged, menarche
- Postpartum, surgery, dental, bruising, nose bleeds, gums
- Disorder
- Von Willibrand panel/Ristocetin Co-Factor, PTT, PT
- REFER to hematology
AUB: Non-Structural: IATROGENIC
M_____/D_____ that contribute to unscheduled bleeding
- Hormonal ______/_ _ \_
-
Anti_____/Anti_____\_
- Atypical antipsychotics: r_____, pali_____, tri___\_
- Anti______\_
- H____/S______: g_____, ch_____, p_____ enzymes
**Clinical Presentation:
Medications/Devices
- Contraceptives/IUDS
- Antidepressants/Antipsychotics
- Risperidone, paliperidone, tricyclic
- Anticoagulants
- Herbs/Supplements: ginseng, chastberry, pineapple enzymes
HMB/prolonged, IMB, amenorrhea
Algorithm
Not listed, first test for amenorrhea -> pregnancy test
Secondary Amenorrhea: Routine Labs/Diagnostic Tests
- Potential Etiology: (3)
- **ROUTINE**: (3)
- PRN (3)
- Brain, Thyroid, Ovaries
- UPT, TSH, PROLACTIN
- Progesterone (mid luteal phase), FSH (abnl>40mlIU/mL), LH, Free testosterone, Uterine evaluation: Endometrial Biopsy
