Abnormal Uterine Bleeding and Climacteric -Gambone Flashcards
What is premenarchial AUB? Reproductive-aged AUB? Postmenopausal AUB? What are each of these normally due to?
premenarchial=prior to menarche tumor, hormonal, foreign objects and cancer
repro-ages (16-44): chronic anovulation (DUB) common
postmenopausal AUB: cancer more common
Bleeding in which age groups requires a work up and follow-up?
premenarchial and post-menopausal
What is Dysfunctional Uterine Bleeding (DUB)?
abnormal uterine bleeding (AUB) in women between menarche and menopause that cannot be attributed to medications, blood dyscrasias, systemic diseases, trauma, uterine neoplasms or pregnancy
Which hormonal cycles can be the cause of DUB?
hypothalamic, pituitary and ovarian
What are the 2 phases of the Endometrial Cycle? Which hormones control each?
Proliferative phase: Estrogen (E2) dominates and causes tissue to grow and proliferate
Secretory phase (after ovulation):
- granulose cells of the CL produce estrogen and progesterone
- progesterone predominates and tissue becomes secretory
What is the new terminology used for AUB?
PALM-COEIN Polyps Adenomyosis Leiomyomas Malignancies Coagulation Defects Ovarian Dysfunction (formerly DUB--> most common) Endometrial causes Iatrogenic (i.e. OC causing withdrawal bleeding) Not Yet Classified
When is DUB normally due to in the perimenopausal age? Adolescence?
perimenopausal==> declining ovarian function
adolescence==> failure of the HPO axis to respond to the + feedback of estrogen
How is DUB diagnosed? What Is the pneumonic he gave us?
diagnose by exclusion
IDS=IDentify the Source of bleeding TO a diagnosis
(IDSTO)
Iatrogenic (ASA, estrogen(OCs), haparin, Tomoxifen, IUD)
Dyscrasias (autoimmune, von willebrands, leukemia)
Systemic Disorders (hepatic, renal (hyperprolactinemia) or thyroid disease)
Trauma
Organic Conditions (preggo complications, malignancies, adenomyoss or endometriosis)
-careful pelvic exam to make sure to ID bleeding site
How is DUB normally treated?
Low dose OCs can be used to control DUB and then regulate cycles in women who are prone to DUB, e.g. PCOS patients
NSAIDs may be effective for light to moderate DUB
Antifibrinolytic agents (tranexsamic acid) may be used and is somewhat more effective than NSAIDs
hormones control 90% of the time
The incidence of ______ is much higher in the postmenopausal age group with DUB
Endometrial Cancer
What is the first thing that should be ruled out in AUB?
pregnancy!*
When does perimenopause take place? what happens?
usually by age 47.
Perimenopause usually lasts 4 to 5 years but may last only 2 years.
Changes in amount, duration of menses and in the length of cycle. Skipped periods are common.
Risk of unintended pregnancy in perimenopause*
Hot Flashes
- Vaginal Discomfort
- Bladder Symptoms
- Heart Disease
- Osteoporosis
What are some Common Symptoms Associated with Estrogen Deficiency?
Vasomotor symptoms: hot flashes, day and night sweats.
Vaginal dryness and dyspareunia.
Stiffness/soreness;insomnia/sleep disturbances; urine leakage; changes in libido; headaches, backaches; mood swings, irritability,anxiety,depression; forgetfulness, plapitations; UTI’s and fatigue.
NOT CAUSALLY RELATED: Major Depressive disorder.
What can help lower risk of coronary artery disease in advancing age?
-Assessment of and counseling on risk factors
–Smoking cessation
–Exercise
–Healthful diet
–Weight loss (lower body mass index) if overweight.
What was found in the Women’s Health Initiative Study? What was the problem with this study?
inc risk of cancer, heart attacks and strokes in the hormone therapy vs placebo group
problem: Randomized control study=all volunteer –> get a bias in the population (old)
