Abnormal Uterine Bleeding: Tate

Question 1

Menorrhagia def:

Answer 1

> 7day prolonged or excessive >80ml uterine bleeding occurring at regular intervals

Question 2

Metrorrhagia de:

Answer 2

Uterine bleeding occurring at irregular but frequent intervals

Question 3

Menometrorrhagia def:

Answer 3

Prolonged uterine bleeding occurring at irregular intervals

Question 4

Hypermenorrhea synonym?

Answer 4

Menorrhagia

Question 5

What is polymenorrhagia?

Answer 5

Bleeding less than every 21 days

Question 6

What is intermenstrual bleeding?

Answer 6

Bleeding variable amounts between regular periods

Question 7

What are the three most common OB complains?

Answer 7

Bleeding
Pelvic pain
Vaginal discharge

Question 8

What are the organic categories of AUB?

Answer 8

Pregnancy
Neoplastic/anatomic
Inflamatory
Trauma
Systemic disease
Drug induced

Question 9

What are the dysfunctional (HPA axis) ranges of AUB?

Answer 9

Postpuberty
During reproductive years
Preimenopausal

Question 10

What are the AUB related to pregnancy?

Answer 10

Implantation
Abortion
Molar-Trophoblastic
Extopic

Question 11

What is implantation bleeding? When?

Answer 11

Minimal
occurs at time of 1st missed cycle
very short (1-2 days)

Question 12

What is abortion bleeding? when?

Answer 12

When baby dies… bleeding

Question 13

What are the five types of AUB abortion?

Answer 13

Threatedned
Inevitable
Complete: it all gets out
Incomplte: part of it gets out
Missed: embryo is still in there

Question 14

What is a molar pregnancy?

Answer 14

Passage of grape like structures (hydropic villi)
SUPER HIGH hCG!!!!!!> 100,000
May have preeclampsia

Question 15

What type of bleeding do we worry about in ectopic pregnancy?

Answer 15

Intraperitoneal

Question 16

STEP: What s a AUB related to neoplasm of vagina?

Answer 16

Diethylestrone exposure=clear cell vaginal cancer

Question 17

What is a AUB related to cervix?

Answer 17

Squamous cell carcinoma

Benign: cervical polyp, necrotic nabothian cyst, etc..

Question 18

What are the most common causes of uterine bleeding?

Answer 18

Fibroids
Endometrial cancer is most common malignancy
Polyp
Adenomyosis

Question 19

DES exposure= what?

Answer 19

Clear cell vaginal tumor

Question 20

Infection/inflammation bleeding is not related to what cycle?

Answer 20

menses

Question 21

What is used for pelvic organ prolapse?

Answer 21

Pessary

Question 22

TEST?: What is MCC menorrhagia in young female who just started menses?

Answer 22

Von Willebrands! Must test.

Question 23

What systemic disorders can lead to AUB?

Answer 23

VWF def
Prothrombin def
Blood dyscrasias: ITP, low platelets, sepsis
Endocrinopathy: hypoThyroid, hyperThyroid, cirrhosis

Question 24

What are main drugs for AUB?

Answer 24

Liver effectors: CYPs: estrogen increases stroke 
Anticoagulation
Salicilates
PG inhibitors
Contraception
Psychotropics

Question 25

What is the cause of post puberty dysfunctional bleeding?

Answer 25

HPA axis not in tune yet... irregular and messy

Question 26

What are the causes of AUB dysfunctional bleeding in reproductive years?

Answer 26

``` Anovulation Polycystic ovarian syndrome thyroid dysfunction pituitary dysfunciton stress increased exercise excessive weight change ```

Question 27

What are the causes of perimenopausal dysfunction?

Answer 27

Ovarian failure... out of eggs | Non secretory Endometrium bleeds

Question 28

What is the go-to for imaging in OB?

Answer 28

Pelvic ultrasound

Question 29

What set of patients have a higher risk of OB cancer?

Answer 29

``` Age 35 or higher Obese Infertile Estrogen exposure Hx of cancer ```

Question 30

What is first line of Tx for AUB?

Answer 30

Estrogen... works quick. Really any birth control pill will be okay if you give more than 1x a day

Question 31

Who do you not give estrogen to?

Answer 31

DVT Stroke CV event

Question 32

What is another drug for AUB?

Answer 32

Progesterone: stops growth NSAIDS: PG inhibitors: not in renal failure

Question 33

Morena is only what hormone?

Answer 33

Progesterone

Question 34

What is surgical management of AUB?

Answer 34

Dilation | Curettage: scrape out the bleeding layer

Question 35

When all else fails... what surgery?

Answer 35

Hysterectomy