AUB (SB) Flashcards
What is the normal interval for menstrual flow?
28 +/- 7 days (21-35 days)
What is the normal duration of menstruation?
4 +/- 2 days (2-6 days)
What is the average menstrual blood loss (MBL)?
35 mL
What laboratory method can be used to measure menstrual blood loss?
Alkaline hematin method
What are key characteristics of abnormal uterine bleeding (AUB)?
Infrequent episodes, excessive flow, prolonged duration, intermenstrual bleeding
What is oligomenorrhea?
Menstrual interval >35 days but <6 months
What is amenorrhea?
No menstruation for at least 6 months
What is the PALM-COEIN classification for AUB?
Polyp, Adenomyosis, Leiomyoma, Malignancy, Coagulopathy, Ovulatory dysfunction, Endometrial, Iatrogenic, Not yet classified
What group in PALM-COEIN represents structural causes of AUB?
PALM (Polyp, Adenomyosis, Leiomyoma, Malignancy)
What group in PALM-COEIN represents nonstructural causes of AUB?
COEIN (Coagulopathy, Ovulatory dysfunction, Endometrial, Iatrogenic, Not yet classified)
What are common features of endometrial polyps?
Localized overgrowth of endometrial tissue, estrogen-stimulated, common in reproductive age, usually benign
What medication is associated with increased risk of malignant polyps?
Tamoxifen
How do endometrial polyps cause abnormal bleeding?
Erosion of surrounding endometrial tissue leading to abnormal or profuse vaginal bleeding
What is adenomyosis?
Presence of endometrial glands and stroma within the myometrium, more than 12mm from the basalis layer
What imaging findings suggest adenomyosis?
Enlarged asymmetric uterus on ultrasound/MRI, anechoic avascular cysts in myometrium
What is the most significant risk factor for adenomyosis?
Multiparity
What are the histologic layers of the endometrium?
Functionalis layer (sloughs off) and Basalis layer (regenerates endometrium)
What are the different types of leiomyoma?
Submucosal, Intramural, Subserosal
Which type of leiomyoma is most associated with AUB?
Submucosal leiomyoma
What is the most common presenting symptom of endometrial cancer?
Abnormal uterine bleeding (AUB)
What systemic disorders can cause AUB due to coagulopathy?
Von Willebrand disease, Prothrombin deficiency, Platelet disorders, Hemophilia A & B
What is the most common cause of AUB?
Ovulatory dysfunction
What age groups are most affected by ovulatory dysfunction-related AUB?
Postmenarcheal and perimenopausal women
What is the underlying mechanism of ovulatory dysfunction-related AUB?
Continuous estrogen stimulation without progesterone leading to endometrial proliferation and irregular shedding
What hormone levels indicate perimenopause-related AUB?
Elevated FSH
What is the hormonal imbalance in PCOS leading to AUB?
Anovulation due to HPO axis dysregulation
What thyroid disorders are associated with AUB?
Hypothyroidism (causes menorrhagia), Hyperthyroidism (causes amenorrhea or infertility)
What prostaglandin imbalances can lead to endometrial-type AUB?
Deficient PGF2α (vasoconstrictor), Excessive PGE (vasodilator)
What infections can cause AUB?
Endometritis, Subclinical Chlamydia trachomatis infection
What medications commonly cause iatrogenic AUB?
Hormonal medications, Estrogens, GnRH agonists/antagonists, OCP misuse, Antibiotics, Anticonvulsants
What foreign objects can cause AUB?
Sex toys, retained objects, trauma
What is the first test to order in a reproductive-age woman with AUB?
Pregnancy test (hCG)
What are the two types of pregnancy tests?
Qualitative (positive/negative) and Quantitative (β-hCG level)
What is a positive β-hCG result?
≥5 mIU/mL
What lab tests assess anemia in AUB?
Hemoglobin, Serum iron, Serum ferritin
What hormone tests help evaluate AUB?
TSH, Prolactin, Androgens (if PCOS suspected)
What imaging modalities are used for AUB workup?
Ultrasound, SHG (Sonohysterogram), Hysteroscopy, MRI
How does a sonohysterogram (SHG) work?
Injects dye and uses X-ray to visualize uterine abnormalities
What is the most specific imaging for adenomyosis?
MRI (junctional zone thickening ≥12mm)
What diagnostic procedure allows direct visualization of the endometrial cavity?
Hysteroscopy
What are the two main types of treatment for abnormal uterine bleeding (AUB)?
Medical and Surgical
What should be considered when choosing between medical and surgical treatment for AUB?
The patient’s response to medical treatment and whether surgical intervention is necessary.
What is the main goal of treatment for AUB?
Identify the cause, create a treatment plan, and control bleeding to prevent hypovolemia.
What are the key factors in assessing AUB?
Acute vs. chronic onset, underlying cause, and response to treatment.
How does progesterone help in AUB treatment?
It opposes estrogen, stops endometrial growth, and ensures uniform sloughing of the endometrium.
What is MPA (medroxyprogesterone acetate) and how is it used?
A form of progesterone given orally or as a depot injection to control AUB.
What is LNG-IUS and how does it work?
Levonorgestrel intrauterine system, a device that releases progesterone continuously for over 5 years to control AUB.
How does estrogen help in AUB treatment?
It promotes rapid growth of endometrial tissue over denuded surfaces and stabilizes the endometrium.
What are examples of estrogen treatments for AUB?
Conjugated equine estrogen (CEE) and oral contraceptive pills (OCPs).
What role do NSAIDs play in AUB management?
They inhibit prostaglandin synthesis, reducing bleeding and cramping.
What are some commonly used NSAIDs for AUB?
Mefenamic acid, ibuprofen, meclofenamate sodium, and naproxen sodium.
When should NSAIDs be taken for AUB?
During the first 3 days of menses or throughout the bleeding episode.
How do antifibrinolytic agents help in AUB?
They inhibit fibrinolysis, preventing excessive bleeding.
What is an example of an antifibrinolytic agent used in AUB?
Tranexamic acid.
What are the side effects of tranexamic acid?
Nausea, dizziness, diarrhea, headaches, abdominal pain, and allergic reactions.
What is the mechanism of action of GnRH agonists in AUB treatment?
They inhibit ovarian steroid production, inducing a hypoestrogenic state.
What are the side effects of GnRH agonists?
Hot flushes, bone loss, acne, and hirsutism.
What is the role of androgens in AUB treatment?
They suppress estrogen production and reduce heavy menstrual bleeding.
What is an example of an androgen used in AUB?
Danazol.
What are the side effects of Danazol?
Weight gain and skin problems, more frequent than with NSAIDs or progestogens.
What is the purpose of dilatation and curettage (D&C) in AUB?
Both diagnostic (biopsy) and therapeutic (removes endometrium to stop bleeding).
When is D&C indicated in AUB patients?
For acute bleeding causing hypovolemia or in older women at risk for endometrial neoplasia.
When is endometrial ablation considered for AUB?
If medical and surgical therapy are ineffective or contraindicated.
When is hysterectomy indicated for AUB?
For patients who have completed their reproductive career or when other treatments fail.
What is the mnemonic for structural causes of AUB?
PALM (Polyp, Adenomyosis, Leiomyoma, Malignancy).
What is the mnemonic for non-structural causes of AUB?
COEIN (Coagulopathy, Ovulatory disorder, Endometrial, Iatrogenic, Not yet classified).
What is the preferred treatment for AUB due to anovulation?
Progesterone therapy to counteract estrogen-driven endometrial proliferation.
How do you manage AUB in a patient with a blood disorder?
Multidisciplinary approach involving hematologists and careful monitoring.
How long does it take for OCPs to control AUB?
Typically around three months.
What should be done if a patient refuses a pregnancy test?
Explain its importance, offer an alternative like ultrasound, and have them sign a refusal form.
Can AUB recur after successful treatment?
Yes, depending on the underlying cause.
What conditions causing AUB typically require surgical management?
Polyp, adenomyosis, leiomyoma, malignancy.
What should be monitored in AUB patients with hyperplasia?
Presence of atypical cells; if unresponsive to treatment, surgery may be needed.
Has the number of AUB cases increased post-pandemic?
There is no accurate report, but cases may have been underreported during the pandemic.
What is the approach for AUB in a stroke-risk patient taking aspirin?
Do not stop aspirin immediately; first rule out other causes and coordinate with a cardiologist.
