Abnormal uterine bleeding and contraception

Question 1

what can cause abnormal uterine bleeding in nongravid reproductive age women

Answer 1

Polyp
Adenomyosis
Leiomyoma
Malignancy and hyperplasia

Coagulopathy
Ovulatory Dysfunction
Endometrial
Iatrogenic
Not yet classified

Question 2

what is an endometrial polyp

Answer 2

hyperplastic overgrowth of glands and stoma

benign

Question 3

what can endometrial polyp cuase

Answer 3

early uterine bleeding

malignancy highger in post menopausal women

Question 4

most common benign tumor in women

Answer 4

leiomyomas “fibroids”

Question 5

Sx leiomyoma

Answer 5

abnormal painful menses

abdominal pain

Question 6

what are subtypes leiomyomas

Answer 6

pedunculated
subserosal
submucosal
intramural

Question 7

what is triad of adenomyosis

Answer 7

nocyclical pain, menorrhagia, enlarged uterus w/o adenexal tenderness

Question 8

Tx adenomyosis

Answer 8

NSAIDs, OCPs, progestins, ablation, hysterectomy

Question 9

fibroids are sensitive to what hormones

Answer 9

E and P

Question 10

complications of fibroids

Answer 10

torsions and infertility

Question 11

what is adenomyosis

Answer 11

endometrial tissue growth in myometrium

Question 12

risk factors fibroids

Answer 12

african american
early menarche
obesity
diet, alcohol, red meats beer
HTN

Question 13

what type of surgeries can you do for fibroids

Answer 13

myomectomy, endometrial ablation, uterine artery embolization, hysterectomy

Question 14

types of degeneration of leiomyoma

Answer 14

hyaline
cystic
red carneous
myxoid

Question 15

common causes postmenopausal women

Answer 15

atrophic endometrium
endometrial polyps
endometrial CA
endometrial hyperplasia
hormonal effects
cervical CA <1%

Question 16

what causes atrophic endometrium

Answer 16

hypoE

dry vaginal epithelium that is smooth and shiny with loss of most rugation

Question 17

why is endometrial hyperplasia weird in postmenopausal women warranting biopsy

Answer 17

because should not have hyperplasia since lack of E

Question 18

what are classifications of endometrial hyperplasia

Answer 18

simple or complex hyperplasia without atypia

simple or complex hyperplasia with atypia

Question 19

most common genital cancer in women over 45

Answer 19

adenoCA of endometrium

Question 20

Tx atrophy of vagina

Answer 20

vaginal estrogen therapy

Question 21

Tx endometrial polyp

Answer 21

polypectomy

Question 22

Tx endometrial hyperplasia

Answer 22

cyclic progestin therapy

Question 23

Tx endometrial hyperplasia with atypia

Answer 23

hysterectomy

Question 24

Tx CA of endometrium

Answer 24

TAH BSO and LND for staging

Question 25

how to Tx menorrhagia

Answer 25

``` ibuprofen transamic acid (expensive) ```

Question 26

how does the implantable rod of contraception work

Answer 26

thickens uterus making in implantable | progesterone only

Question 27

problems with etonogestrel implant

Answer 27

increase bleeding and spotting | irregularity and unpredictability

Question 28

side effects etonogestrel implant

Answer 28

weight gain

Question 29

CI etonogestrel implant

Answer 29

SLE with anti phospholipid Ab hepatocellular adenoma discontinue if have migraines with aura unexplained vaginal bleeding before evaluation

Question 30

What is paragard

Answer 30

copper IUD no hormones--- can have heavier bleeding lasts 10 years

Question 31

what is mirena

Answer 31

levonorgestrel IUD local progestin lasts 5 years

Question 32

what disease not use copper IUD

Answer 32

wilsons disease

Question 33

how does copper IUD work

Answer 33

alters uterine and tubal fluid hinders spermatozoa function inhibits fertilization! not abortifacient

Question 34

how does mirena work

Answer 34

impaires spermatozoa motility/function | inhibits conception

Question 35

which IUD has no weight gain

Answer 35

mirena

Question 36

contraindications to IUD

Answer 36

current PID or within past 3 mo current cervicitis high risk women: screen first for STIs

Question 37

what is depot provera

Answer 37

progesterone shot every 3 mo | thickens cervical mucus

Question 38

side effects depot provera

Answer 38

bleeding irregularities weight gain delayed return fertility decrease in bone mineral density

Question 39

how does depot provera change BMD

Answer 39

loss of BMD | returns to baseline once discontinued

Question 40

few CI to depot provera

Answer 40

severe HTN | DM with vascular disease

Question 41

special populations to use depot provera

Answer 41

sickle cell | epileptics

Question 42

which contraceptive use is weight dependent

Answer 42

the patch | >90 kg doesn't work

Question 43

what is in nuva ring

Answer 43

ethinyl estradiol | etonorgestrel

Question 44

when is back up method for nuva ring needed

Answer 44

taken out for greater than 3 hours

Question 45

what increases weight

Answer 45

depot provera

Question 46

breakthrough bleeding more common in

Answer 46

smokers | cervical infections

Question 47

CI to oral contraception

Answer 47

``` Hx VTE known thrombogenic mutation migraines WITH aura HTN poorly controlled lupus with antiphospholipid Ab (hypercoaguable) ```

Question 48

method for protection from STIs

Answer 48

condoms