Bleeding D.O. Flashcards
normal length of menarche
after puberty (5-6 yrs) long, and again in 40s
typically 4-6 days with 20-60 cc of blood loss
avg iron loss in menarche
13 mg
mc complaint to GYN office
abnormal uterine bleeding
AUB
menstrual bleeding of abnormal quantity, duration, schedule
MUST work it up
polymenorrhagia
periods occur more than once a month
anovulatory cycles and lack of progesterone to stabilize and organize endometrium
metorrhagia
intramenstrual spotting
menorrhagia
heavy, prolonged flow
clots are not abnormal but gushing
hypomenorrhea
unusually light menstrual how or spotting
menometorrhagia
heavy bleeding at irregular intervals
oligomenorrhea
> 35 days between periods
contact/post coital bleeding cause
cervical CA until proven otherwise
PE of pelvic complaint
PAP, STI screen
bimanual exam
lab eval of AUB
TSH, hCG, coagulation test, Pap smear
progesterone challenge test
imaging AUB
transvaginal ultrasound
what must you have to diagnose someone with dysfunctional uterine bleed
r.o. AUB 2/2 meds, clotting disorders, systemic dz, pregnancy or tumor
DUB cause?
disruption in normal cyclic pattern of ovulatory hormonal stimulation of endometrial lining
DUB pathophys
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
DUB management
- r.o pregnancy
- local or systemic disease
- iatrogenic causes
adolescents and DUB
common in teens, r.o pregnancy
can give OC for 6 months to see if this helps
premenopausal women and DUB
increased concern for malignancy (esp. endometrial CA)
therefore, w/u includes hysteroscopy and endometrial bx
