Abnormal Uterine Bleeding: Tate Flashcards
Menorrhagia def:
> 7day prolonged or excessive >80ml uterine bleeding occurring at regular intervals
Metrorrhagia de:
Uterine bleeding occurring at irregular but frequent intervals
Menometrorrhagia def:
Prolonged uterine bleeding occurring at irregular intervals
Hypermenorrhea synonym?
Menorrhagia
What is polymenorrhagia?
Bleeding less than every 21 days
What is intermenstrual bleeding?
Bleeding variable amounts between regular periods
What are the three most common OB complains?
Bleeding
Pelvic pain
Vaginal discharge
What are the organic categories of AUB?
Pregnancy Neoplastic/anatomic Inflamatory Trauma Systemic disease Drug induced
What are the dysfunctional (HPA axis) ranges of AUB?
Postpuberty
During reproductive years
Preimenopausal
What are the AUB related to pregnancy?
Implantation
Abortion
Molar-Trophoblastic
Extopic
What is implantation bleeding? When?
Minimal
occurs at time of 1st missed cycle
very short (1-2 days)
What is abortion bleeding? when?
When baby dies… bleeding
What are the five types of AUB abortion?
Threatedned Inevitable Complete: it all gets out Incomplte: part of it gets out Missed: embryo is still in there
What is a molar pregnancy?
Passage of grape like structures (hydropic villi)
SUPER HIGH hCG!!!!!!> 100,000
May have preeclampsia
What type of bleeding do we worry about in ectopic pregnancy?
Intraperitoneal
STEP: What s a AUB related to neoplasm of vagina?
Diethylestrone exposure=clear cell vaginal cancer
What is a AUB related to cervix?
Squamous cell carcinoma
Benign: cervical polyp, necrotic nabothian cyst, etc..
What are the most common causes of uterine bleeding?
Fibroids
Endometrial cancer is most common malignancy
Polyp
Adenomyosis
DES exposure= what?
Clear cell vaginal tumor
Infection/inflammation bleeding is not related to what cycle?
menses
What is used for pelvic organ prolapse?
Pessary
TEST?: What is MCC menorrhagia in young female who just started menses?
Von Willebrands! Must test.
What systemic disorders can lead to AUB?
VWF def
Prothrombin def
Blood dyscrasias: ITP, low platelets, sepsis
Endocrinopathy: hypoThyroid, hyperThyroid, cirrhosis
What are main drugs for AUB?
Liver effectors: CYPs: estrogen increases stroke Anticoagulation Salicilates PG inhibitors Contraception Psychotropics
What is the cause of post puberty dysfunctional bleeding?
HPA axis not in tune yet… irregular and messy
What are the causes of AUB dysfunctional bleeding in reproductive years?
Anovulation Polycystic ovarian syndrome thyroid dysfunction pituitary dysfunciton stress increased exercise excessive weight change
What are the causes of perimenopausal dysfunction?
Ovarian failure… out of eggs
Non secretory Endometrium bleeds
What is the go-to for imaging in OB?
Pelvic ultrasound
What set of patients have a higher risk of OB cancer?
Age 35 or higher Obese Infertile Estrogen exposure Hx of cancer
What is first line of Tx for AUB?
Estrogen… works quick. Really any birth control pill will be okay if you give more than 1x a day
Who do you not give estrogen to?
DVT
Stroke
CV event
What is another drug for AUB?
Progesterone: stops growth
NSAIDS: PG inhibitors: not in renal failure
Morena is only what hormone?
Progesterone
What is surgical management of AUB?
Dilation
Curettage: scrape out the bleeding layer
When all else fails… what surgery?
Hysterectomy
