AUB Flashcards
What is the differential dx for AUB
P- polyps
A- adenomyosis
L- Leiomyomas
M- malignancy
C- coagulopathy
O- ovarian dysfunction
E- Endometrial
I- iatrogenic
N- not otherwise specified
How do you work up AUB
H&P
TVUS
Labs– CBC, TSH, hCG, Pap smear, ?STI test
Consider underlying hemostatic disorder
- Heavy menses since menarche
- One or more of the following: PPH, surgery related bleeding, bleeding with dental work
- Two or more of the following: bruise 1-2/mo, epistaxis 2x/mo, frequent gum bleeds, fam hx of bleeding
When is EMB indicated
AUB >45yo
If <45yo with unopposed estrogen exposure, failed medical management, or persistent AUB
How is von Willebrands disease inherited
Type I- AD
Type 2- AR
Type 3- AR/AD
How do you diagnose vWD?
Ristocetin co-factor activity (vWF activity)
How do you treat AUB 2/2 vWD
OCPs, LNG-IUD
Desmopressin
Antifibrinolytics (TXA)
Plasma-derived concentrates of vWF
Avoid ASA and NSAIDs
What is the Ddx for hirsutism
Familial
PCOS
Congential adrenal hyperplasia
Androgen secreting tumor
Drugs
Hypothyroidism
Severely elevated PRL
Cushing’s disease
A pt presents with hirsutism, what is the workup?
Total testosterone
DHEAS
17-OH progesterone
What is the tx for hirsutism
Multimodal approach
- OCPs– oral estrogen increases SBHG, some hormones are less androgenic, drospirenone also has spironolactone-like properties
- Spironolactone– competitive inhibitor of androgen receptor, also decreases conversion of T to DHT
- Finasteride – inhibits 5alpha reductase
- Flutamide– androgen receptor agonist
- Topical eflornithine– irreversible inhibition of ornithine decarboxylase of the skin
- Depilation
- Physical removal of hair
- weight loss if obese– increases SHBG to decrease free testosterone
What is PCOS
Hyperandrogenic chronic anovulation syndrome
Causes 2/2 amenorrhea
Associated with metabolic syndrome and insulin resistance
What are the Rotterdam criteria of PCOS
Two of the following present:
- Oligomenorrhea or anovulation
- Hyperandrogenism (clinical or biochemical)
- Polycystic ovaries
— >12 follicles per ov in either ovary (2-9 mm in diameter)
— Increased ovarian volume >10mL
— Finding required in only one ovary needed
What is the work up for PCOS
H&P
Labs– testosterone and SHBG or total and free testosterone, prolactin, CBC, 17-OH progesterone, TSH, HgbA1c, GTT-2hr, fasting lipid profile
What is the treatment of PCOS
Lifestyle modifications
OCPs/progestins
Metformin
Infertility:
Letrazole
Clomiphene
What is metabolic syndrome
3 or more of the following:
Waist circumference >35
Fasting glucose >100
Trigylcerides >150
Blood pressure >130/85
HDL cholesterol <50
