abnormal uterine bleeding, paps Flashcards
causes of abnormal uterine bleeding
PALM-COEIN polyp adenomyosis leiomyoma malignancy and hyperplasia coagulopathy ovulatory dysfunction endometrial iatrogenic not yet classified
endometrial polyp
hyperplastic overgrowths of endometrial glands and stroma
generally benign, but malignancy highest in postmenopausal women
can be E dependent
fibroids
most common benign neoplasia of female genitals smooth m and CT E/P sensitive rarely become leiomyosarcoma can cause torsions and infertility
adenomyosis
triad- noncyclical pain, menorrhagia, enlarged uterus w/adnexal tenderness
Tx- NSAIDS, OCPs, ablation, hyseterectomy
risk factors for fibroids
2-3x higher in african americans early emnarche obesity diet, alcohol, red meats, beer HTN
leiomyoma-myxoid degneration
larger leiomyomas outgrow blood supply undergo degeneration which can be hyaline, cystic, red carneous, or myxoid
atrophic endometrium
most common cause of abnormal bleeding
hypoestrogen -> atrophy of endometrium
vag usually pale, dry, smooth and shiny with loss of rugation
bacterial vaginosis
no inflammation therefore no pain or itching
overgrowth of normal flora anaerobic bacteria
loss of lactobacilli
Dx of bacterial vaginosis
3+: homogenous white-gray discharge pH>4.5 \+whiff test with KOH clue cells gram stain is gold standard, but rarely done PCR-based assay
Tx of bacterial vaginosis
metronidazole (no alcohol)
clindamycin
tindazole
trichomonas
bc motile causes bubbly appearance
ASCUS
atypical squamous cells of undetermined significance
ASC-H
atypical squamous cells- high grade
AGUS
atypical glandular cells of undetermined significance
LSIL
low grade squamous intraepithelial lesion
HSIL
high grade squamous intraepithlial lesion
screening 21-29
cytology alone every 3 years
screening
cytology and HPV testing every 5 years
recommendations to stop screening
65 with no CIN2+ in the last 20 yrs
plus either 3 consecutive paps or 2 consecutive negative HPV tests
can also stop after hysterctomy with removal of cervix and no CIN2+ Hx
when should you not stop
Hx of CIN2, 3, AIS
arm implant
etonogestrel
3 years
.05% failure
ADR and CIs of arm implant
can have irregular spotting acne can cause bone mineral density decrease SLE hepatocellular adenoma migraines with aura unexplained vag bleeding before implantation
paragaurd
copper IUD up to 10 yrs heavier periods no side effects CI in wilsons disease
mirena
local progestin
up to 5 yrs
lighter-no periods
some rare side effects
mechanism of cooper IUDs
mass effect
alters uterine and tubal fliud hinders sperm fnx and motility
inhibits fertilization
NOT abortifacient
mechanism of mirena
impairs sperm motility/fnx inhibits contraception thickens cervical mucus atrophy of endometrium impairs tubal motility
depo provera
medroxyporgesterone acetate every 3 months bleeding irregularities delayed return of fertility weight gain decrease in bone mineral density
CI of depo provera
severe HTN
DM with vascular disease and or >20 yrs of disease
