AUB & DUB Flashcards
what is abnormal uterine bleeding (AUB)
any pattern of bleeding other than reg. ovulatory cycles
what is dysfunctional uterine bleeding (DUB)
AUB that CANNOT be attributed to medications, blood dyscrasias, systemic diseases, trauma, infection, uterine neoplasms, preg
what is the effect of estrogen on the endometrium
growth, proliferation
what happens after the LH surge
ovulation and the CL forms
what is happening in the secretory endometrium
the CL produces estrogen and progestrone
If no CL, what happens to E and P
its drops –> synchornized sloughing of the endometrium (aka period), mostly d/t the drop in progesterone
what limits the bleeding
prostaglandins –> increasing levels creates endometrial ischemia
what happens to E and P in anovulatory cycle
no progesterone rise BUT estrogen is normal ( i think)
without progesterone what happens to the lining
it keeps proliferating, thus having sporadic bleeding, no ovulation, partial sloughing of endometrium
why do you bleed then in anovulatory cycle
bleeding is caused by the inability of estrogen - that needs to be present to stimulate the endometrium in the first place - to support a growing endometrium
is the bleed heavy or light, and why
heavy, bc there are lower levels of prostaglandins –> less vasoconstriction
what happens in repeated anovulatory cycles
increased likelihood of:
- excessive blood loss
- endometrial hyperplasia
- endometrial carcinoma
Menorrhagia
Excessive or prolonged menses at normal interval - >80cc or 7 days
polymenorrhagia
more frequent menses
interval <21 days cycle
metrorrhagia
irregular menses
Menometrorrhagia/Metromenorrhagia
heavy, irregular menses
oligo-amenorrhea
> 35 day interval over a 6 month period
amenorrhea
no menses for 3 months
causes of AUB
medications, blood dyscrasias, systemic diseases, trauma, infection, uterine neoplasms
break-through bleeding
a SE of BCP that shoudl go away by 3rd month; can be controlled by changing the type of COCP
BCP
all BCP has teh same estrogen (EE) but at different doses, the only thing thats differs btwn pills is the progestin
-goal of COCP is to control birth and cycle
Depo-provera
IM injection of pure progesterone (every 3 months)
what happens with constant progesterone
causes the lining to thin out (thus won’t bleed)
SE of depo-provera and why its a cuase of AUB
eventually can lead to all bleeding patterns
IUD
- can cause menorrhagia - you got something foreign up there, it can bleed
- ones with progesterone in it can cause lighter, shorter bleeding
what blood dyscrasias mentioned in class can cause AUB
Von Willebrand’s Disease
systemic diseases of liver, renal and what else
Thyroid - most common
- hypothyroidism –> won’t have ovulatory cycles
- so fix this and you’ll fix AUB
what infections can cause AUB
- cervicitis
- endomyometritis
- PID
types of benign neoplasms that can cuase AUB
- endocervical polyps - post-sex bleeding
- endometrial polyps
- leiomyomas
- adenomyosis
- endmetrial hyperplasia
malignany neoplasms that can cause AUB
- cervical carcinoma
2. uterine carcinoma
if pts is post-meno and bleeding
think cancer
DUB most commonly occurs in what age group
just menstruating (11-14) premenopausal
what is DUB almost always caused by
aberrations of the hypothalamic-pit-ovarian axis –> anovulation
FIGO classification of AUB
PALM-COEIN
-sidenote: PALM- are more structural parts
AUB-P
polyps (endometrial or cervical)
AUB- A
Adenomyosis
AUB - L
leiomyomata
AUB- M
Malignancy or pre-malig
- endometrial carcinoma
- endometrial hyperplasia
AUB -C
Coagulopathy
-VW’s , anti-coagulants
AUB-O
(An)Ovulatory
AUB-E
endometrial
- combo of asymptomatic polyps, adenomyosis, leiomyomata
AUB - I
Iatrogenic (hormonal pills)
- gonadal steriods
- -E and P, androgens
- gonadal-related therapy
- -GnRH agonists, SERM, progesterone receptor modulators
AUB -N
not classified
what is wrong with the endometrium in DUB (>35 yrs better becareful)
usually prolifertaive or discordant endometrium
-result of ‘unoppsed estrogen’
what is DUB associated with
PCOS, anovulatory or oligo-anovulatory cycles
whats the first thing you need to do for DUB work up
R/O preggers !!
and later malignancy
DUB physical exam
make sure its the uterine
r/o truama, infection, neoplasms
DUB pelvic u/s
endometrial thickness (<4 in you good- postmeno)
polyps
fibroids
DUB labs
CBC, serum Fe and TIBC, hCG, TFT, LFT, prolactin, serum progest in Luteal phase, FSH
DUB tissue eval
pap smear, endometrial biopsy, hysteroscopy, D&C
how do you treat moderate DUB
BCP - used for more predictable, shorter, lighter, less painful bleeding
cyclic E and P
cyclic P - for DVT and >35 yrs
Cyclic E and P plan
- Conjugated estrogen 1.25mg or micronized estradiol 2mg for 25 days
- Medroxy-progesterone acetate 10mg or Megace 5mg days 16-25
- Drug-free for the rest of the month
cyclic P plan
- Medroxy-progesterone acetate 10mg, Norethindrone 5mg or Megace 5mg for 10 days each month
- Counting on their own estrogen making
how do you treat severe DUB
- IV Conjugated estrogens 25mg every four hours until it subsides for 24 hours.
- -Can stop any bleeding with this
- -And then change them onto oral regimen and follow up
- Change to Conjugated estrogen 1.25mg or 2mg of micronized estradiol PO every 4-6 hours for 24 hours.
- Taper to the same dose PO daily for 7-10 days.
- Follow with progesterone for 10 days.
what do you do if hormonal is ineffective
hysteroscopy, D&C (the good ole’ Look and Suck)
if hysteroscopy, D&C is ineffective and NOT worried about baby making
endometrial ablation
hysterectomy
