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Reproductive Exam 2 > AUB & DUB > Flashcards

AUB & DUB Flashcards

1
Q

what is abnormal uterine bleeding (AUB)

A

any pattern of bleeding other than reg. ovulatory cycles

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2
Q

what is dysfunctional uterine bleeding (DUB)

A

AUB that CANNOT be attributed to medications, blood dyscrasias, systemic diseases, trauma, infection, uterine neoplasms, preg

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3
Q

what is the effect of estrogen on the endometrium

A

growth, proliferation

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4
Q

what happens after the LH surge

A

ovulation and the CL forms

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5
Q

what is happening in the secretory endometrium

A

the CL produces estrogen and progestrone

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6
Q

If no CL, what happens to E and P

A

its drops –> synchornized sloughing of the endometrium (aka period), mostly d/t the drop in progesterone

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7
Q

what limits the bleeding

A

prostaglandins –> increasing levels creates endometrial ischemia

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8
Q

what happens to E and P in anovulatory cycle

A

no progesterone rise BUT estrogen is normal ( i think)

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9
Q

without progesterone what happens to the lining

A

it keeps proliferating, thus having sporadic bleeding, no ovulation, partial sloughing of endometrium

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10
Q

why do you bleed then in anovulatory cycle

A

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

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11
Q

is the bleed heavy or light, and why

A

heavy, bc there are lower levels of prostaglandins –> less vasoconstriction

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12
Q

what happens in repeated anovulatory cycles

A

increased likelihood of:

  1. excessive blood loss
  2. endometrial hyperplasia
  3. endometrial carcinoma
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13
Q

Menorrhagia

A

Excessive or prolonged menses at normal interval - >80cc or 7 days

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14
Q

polymenorrhagia

A

more frequent menses

interval <21 days cycle

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15
Q

metrorrhagia

A

irregular menses

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16
Q

Menometrorrhagia/Metromenorrhagia

A

heavy, irregular menses

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17
Q

oligo-amenorrhea

A

> 35 day interval over a 6 month period

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18
Q

amenorrhea

A

no menses for 3 months

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19
Q

causes of AUB

A

medications, blood dyscrasias, systemic diseases, trauma, infection, uterine neoplasms

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20
Q

break-through bleeding

A

a SE of BCP that shoudl go away by 3rd month; can be controlled by changing the type of COCP

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21
Q

BCP

A

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

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22
Q

Depo-provera

A

IM injection of pure progesterone (every 3 months)

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23
Q

what happens with constant progesterone

A

causes the lining to thin out (thus won’t bleed)

24
Q

SE of depo-provera and why its a cuase of AUB

A

eventually can lead to all bleeding patterns

25
Q

IUD

A
  • can cause menorrhagia - you got something foreign up there, it can bleed
  • ones with progesterone in it can cause lighter, shorter bleeding
26
Q

what blood dyscrasias mentioned in class can cause AUB

A

Von Willebrand’s Disease

27
Q

systemic diseases of liver, renal and what else

A

Thyroid - most common

  • hypothyroidism –> won’t have ovulatory cycles
  • so fix this and you’ll fix AUB
28
Q

what infections can cause AUB

A
  • cervicitis
  • endomyometritis
  • PID
29
Q

types of benign neoplasms that can cuase AUB

A
  1. endocervical polyps - post-sex bleeding
  2. endometrial polyps
  3. leiomyomas
  4. adenomyosis
  5. endmetrial hyperplasia
30
Q

malignany neoplasms that can cause AUB

A
  1. cervical carcinoma

2. uterine carcinoma

31
Q

if pts is post-meno and bleeding

A

think cancer

32
Q

DUB most commonly occurs in what age group

A 
just menstruating (11-14)
premenopausal
33
Q

what is DUB almost always caused by

A

aberrations of the hypothalamic-pit-ovarian axis –> anovulation

34
Q

FIGO classification of AUB

A

PALM-COEIN

-sidenote: PALM- are more structural parts

35
Q

AUB-P

A

polyps (endometrial or cervical)

36
Q

AUB- A

A

Adenomyosis

37
Q

AUB - L

A

leiomyomata

38
Q

AUB- M

A

Malignancy or pre-malig

  • endometrial carcinoma
  • endometrial hyperplasia
39
Q

AUB -C

A

Coagulopathy

-VW’s , anti-coagulants

40
Q

AUB-O

A

(An)Ovulatory

41
Q

AUB-E

A

endometrial

- combo of asymptomatic polyps, adenomyosis, leiomyomata

42
Q

AUB - I

A

Iatrogenic (hormonal pills)

  • gonadal steriods
  • -E and P, androgens
  • gonadal-related therapy
  • -GnRH agonists, SERM, progesterone receptor modulators
43
Q

AUB -N

A

not classified

44
Q

what is wrong with the endometrium in DUB (>35 yrs better becareful)

A

usually prolifertaive or discordant endometrium

-result of ‘unoppsed estrogen’

45
Q

what is DUB associated with

A

PCOS, anovulatory or oligo-anovulatory cycles

46
Q

whats the first thing you need to do for DUB work up

A

R/O preggers !!

and later malignancy

47
Q

DUB physical exam

A

make sure its the uterine

r/o truama, infection, neoplasms

48
Q

DUB pelvic u/s

A

endometrial thickness (<4 in you good- postmeno)
polyps
fibroids

49
Q

DUB labs

A

CBC, serum Fe and TIBC, hCG, TFT, LFT, prolactin, serum progest in Luteal phase, FSH

50
Q

DUB tissue eval

A

pap smear, endometrial biopsy, hysteroscopy, D&C

51
Q

how do you treat moderate DUB

A

BCP - used for more predictable, shorter, lighter, less painful bleeding
cyclic E and P
cyclic P - for DVT and >35 yrs

52
Q

Cyclic E and P plan

A
  • 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
53
Q

cyclic P plan

A
  • Medroxy-progesterone acetate 10mg, Norethindrone 5mg or Megace 5mg for 10 days each month
  • Counting on their own estrogen making
54
Q

how do you treat severe DUB

A
  • 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.
55
Q

what do you do if hormonal is ineffective

A

hysteroscopy, D&C (the good ole’ Look and Suck)

56
Q

if hysteroscopy, D&C is ineffective and NOT worried about baby making

A

endometrial ablation

hysterectomy

Reproductive Exam 2 (5 decks)

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