AUB

Question 1

What is normal menstrual bleeding

Answer 1

• q21-35 days
• lasting < 5-7 days
• less than 80 mL

Question 2

when should you screen for coagulopathy?

Answer 2

Heavy menses since menarche plus:

1 of:

• PPH
• heavy surgical related bleeding
• dental work related bleeding

2 of:

• bruising 2x/month
• epistaxis 2x/month
• frequent gum bleeding
• family hx of bleeding

Question 3

who to perform EMB

Answer 3

• all pts 45 and up
• any pt with unopposed estrogen/risk factors
• persistent despite medical/surgical management

Question 4

what is detection rate of emb for endometrial cancer?

Answer 4

• 99.6% post menopausal
• 91% premenopausal
• 81% hyperplasia

should include both stromal and glandular components

Question 5

what does plasma cells on EMB represent? neutrophils? lymphocytes?

Answer 5

plasma cells = chronic endometritis
neutrophils = acute endometritis
lymphocytes = normal

Question 6

what is treatment for acute heavy uterine bleeding?

Answer 6

• consider premarin 25 mg IV q4hr x 6 doses

- D&C if needed

Question 7

for adolescent with heavy menses due to HPO axis immaturity, what are treatments?

Answer 7

based on level of anemia

• Mild, Hct > 33% or Hgb > 11 -> iron, if desires then OCPs for contraception
• moderate Hct 27-33%, Hg 9-11 -> OCPs + iron
• severe, Hct < 27%, Hgb less than 9 -> OCP taper, then OCPs + Fe