Abnormal Uterine Bleeding - Schoyer Flashcards
Define polymenorrhea
frequent menstruation with bleeding intervals shorter than 21 days
Define menorrhagia
excessive menstrual bleeding (flow >80mL and/or duration >7 days)
Define metrorrhagia
irregular menstrution intervals
Define menometrorrhagia
irregular menstruation intervals with excessive flow and/or duration
Define oligomenorrhea
menstruation fewer than 9 times per year (average bleeding intervals >35 days
Define hypomenorrhea
Very light or short-duration menstruation
What is intermenstrual bleeding?
Uterine bleeding in between apparently normal ovulatory menses
What is a uterine fibroid?
What symptoms are associated with uterine fibroids?
Uterine leiomyoma - a benign neoplasm of the uterus
Symptoms depend on exact location of the fibroid(s), but may include:
- Menorrhagia/menometrorrhagia with refractory anemia
- Intermenstrual dysmenorrhea
- Mass symptoms (urinary pressure/urgency, constipation, flank pain, increasing abdominal girth
At what age do uterine fibroids typically present?
Are they hormonally responsive?
Most prevalent during reproductive years. They rarely present during puberty and often regress after onset of menopause
Yes, they are hormonally responsive -> Leiomyomas have increased amounts of both estogen and progesterone receptor mRNA
Name (3) benign neoplasms of the uterus
Endometrial polyps
Endocervial polyps
Adenomyosis
In what layer of the uterus are endometrial polyps found?
Endocervical polyps?
Adenomyosis?
As fleshy outgrowths of the endometrium
As outgrowths of cervical mucosa
As a benign invasion of the endometrium into the myometrium
Anovulation and abnormal uterine bleeding are most common at what ages?
What usually drives formation of these symptoms? What happens structurally to the uterus?
Discuss the relevance of this process to neoplasms of the uterus
Common at the extremes of reproductive age
Often due to chronic exposure of the endometrium to estrogen without cyclic exposure to postovulatory progesterone. This causes the endometrium to become abnormally thickened and structurally incompetent. Asynchronous shedding occurs without progesterone-driven vasoconstriction, often leading to heavy bleeding.
Abnormal cycling predisposes patients to endometrial hyperplasia and endometrial cancer. Increased risk is proportional to the duration of unoppose estrogen exposure.
Name two major types of uterine malignant neoplasms
Endometrial cancer
Cervical cancer
How is endometrial cancer usually diagnosed?
Endometrial biopsy or endometrial curettage/hysteroscopy specimens
‘Spotting’ is often related to what?
Maybe it doesn’t seem like a big deal -> why is it actually a big deal?
Endometrial atrophy related to hypoestrogenism
Endometrial atrophy with spotting is clinically indistinguishable from the earliest symptoms of endometrial cancer and therefore requires extensive workup and careful evaluation to rule out cancer. This is especially true in peri-/post-menopausal women.
