AUB Flashcards
Adenomyosis MUSA criteria (8)
asymmetrical thickening
fan-shaped shadowing
translesional vascularity
irregular junctional zone
myometrial cysts
hyperechoic islands
echogenic subendometrial lines and buds
interrupted junctional zone
changes AUB classification 1
1) frequency: amenorrhea included
2) duration: normal 8 and below
3): frequency: 24-38
4) regularity: normal cycle interval is <7-9 days, irregular >8-10 days
5) HMB NIH definition of disrupts QOL
6) included if intermenstrual scheduled/cyclic or random
7) included if breakthrough bleeding while on pills/meds
COIEN changes
medication under iatrogenic
n = not otherwise classified including isthmocele and av malformation
chronic aub
6 months
PALM changes
MUSA criteria for adeno
AUB-L: type 3 is SM
0 vs 1, 6 vs 7 –> pedicle has to be 10% of mass diameter
2 vs 3: need hystero with minimal visualization
AUB-C criteria
1) heavy menses since menarche
2) one of the following:
postpartum hemorrhage
surgical related bleeding
bleeding associated with dental work
3) two or more:
bruising 1-2x/month
epistaxis 1-2x/month
frequent gum bleeding
fam hx of bleeding sx
menses MOA
progesterone withdrawal > destabilizes lysososme membrane > release of MMPs, acid phosphatase > enzymatic degradation of functionalis layer
progesterone withdrawal > release of inflammatory cells
end of menses MOA
vasoconstriction in the denuded spiral arterioles in the basal layer of the endometrium and also possibly in the radial arteries of the superficial myometrium.
mediated by prostaglandins esp PGF2a
estrogen withdrawal bleeding
as in those post BSO or estrogen only pills
estrogen breakthrough bleeding
as in PCOS or those with chronic anovulation/unopposed estrogen
progesterone withdrawal
ex as in progestin challenge test
progesterone breakthrough bleeding
ex those on dienogest or DMPA
MOA anovulatory bleeding
patchy endometrial growth but no dominant follicle - Em proliferates and outgrows blood supply = fragile EM > bleed and regrow patchy
MOA AUB myoma (8)
increased surface area
uterine venous ectasia
fragile and engorged vessels
impaired platelet action
increase in TGFB3
molecular changes (VEGF, MMP, bFGF)
impaired myometrial contractility
impaired vasoconstriction
von Willebrand disease
vWf needed for platelet action and hemostasis
most common cause of coagulopathy
LABS
pregnancy test
CBC, blood typing
Iron studies
crea, bun, AST, ALT
PT/PTT
TV-UTZ
TSH, PRL
estradiol, LH, FSH
papsmear
EM bx
mammography (if applicable)
Acute Heavy Menses (Anovulatory)
Requirement: thickened EM to suggest estrogen exposure
High dose progestin x 7-10 days then OD x 3 weeks
MPA 10-20mg BID
Megace 20-40mg BID
NETA 5mg BID
E-P regimens (20-25mcg)
4 pills x 1 week
3 pills x 1 week
2 pills x 1 week
1 pill x 1 week
stop
1 pill x 1 week
Maintenance AUB (Anovulatory)
OCP
Cyclic Progestin (like MPA 5-10 mg OD 10-14days per month)
DMPA 150mg q3months
LNG-IUS
E-P (30-35mcg)
QID x 4 days
TID x 3 days
BID x 2 days
OD x 3 weeks
progestin MOA antiestrogen
1) inc 17BHSD and sulfotransferase to convert E2 to E3 and be rapidly cleared
2) inhibit induction of estrogen receptor
3) inhibit transcription of oncogenes
Acute HMB with THIN EM
CEE 25mg IVq4 x 24 hours
then 2.5mg PO q6 or micronized estradiol 2mg OD until bleeding stops then taper to OD, add a progestin for 7-10 days
consider switching to OCP after
Adjuncts to AUB
anti-fibrinolytic
Tranexamic Acid 1g IV q8 or 500mg 2tabs q8
NSAIDs
Ibuprofen 400mg TID
Mefenamic Acid 500mg TID
Pregnancy risk of Myoma
- PTB
- Malpres
- RPL
- Hemorrhage
- Previa
- Dysfunctional labor
- IUGR
- IUFD
