Bleeding D.O.

Question 1

normal length of menarche

Answer 1

after puberty (5-6 yrs) long, and again in 40s

typically 4-6 days with 20-60 cc of blood loss

Question 2

avg iron loss in menarche

Answer 2

13 mg

Question 3

mc complaint to GYN office

Answer 3

abnormal uterine bleeding

Question 4

AUB

Answer 4

menstrual bleeding of abnormal quantity, duration, schedule

MUST work it up

Question 5

polymenorrhagia

Answer 5

periods occur more than once a month

anovulatory cycles and lack of progesterone to stabilize and organize endometrium

Question 6

metorrhagia

Answer 6

intramenstrual spotting

Question 7

menorrhagia

Answer 7

heavy, prolonged flow

clots are not abnormal but gushing

Question 8

hypomenorrhea

Answer 8

unusually light menstrual how or spotting

Question 9

menometorrhagia

Answer 9

heavy bleeding at irregular intervals

Question 10

oligomenorrhea

Answer 10

> 35 days between periods

Question 11

contact/post coital bleeding cause

Answer 11

cervical CA until proven otherwise

Question 12

PE of pelvic complaint

Answer 12

PAP, STI screen

bimanual exam

Question 13

lab eval of AUB

Answer 13

TSH, hCG, coagulation test, Pap smear

progesterone challenge test

Question 14

imaging AUB

Answer 14

transvaginal ultrasound

Question 15

what must you have to diagnose someone with dysfunctional uterine bleed

Answer 15

r.o. AUB 2/2 meds, clotting disorders, systemic dz, pregnancy or tumor

Question 16

DUB cause?

Answer 16

disruption in normal cyclic pattern of ovulatory hormonal stimulation of endometrial lining

Question 17

DUB pathophys

Answer 17

lose cyclic endometrial stimulation arising from ovulatory cycle

2/2 anovulatory cycles

insufficiente progestin to stabilize endometrium = uninterrupted endometrial growth and periodic shedding at irregular intervals

Question 18

DUB management

Answer 18

1. r.o pregnancy
2. local or systemic disease
3. iatrogenic causes

Question 19

adolescents and DUB

Answer 19

common in teens, r.o pregnancy

can give OC for 6 months to see if this helps

Question 20

premenopausal women and DUB

Answer 20

increased concern for malignancy (esp. endometrial CA)

therefore, w/u includes hysteroscopy and endometrial bx