Ch 1 Abnormal Uterine Bleeding

Question 1

normal menses are defined as vaginal bleeding that occurs approx q 28days (w/ range 21-35days) lasts 4-7days.

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Question 2

vaginal bleeding is HEAVY if loses more than 80ml of blood per cycle (normal 30-35ml”)

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Question 3

benign abnormal bleeding
ORganic (not hormonal) - systemic health probs, abnormal pregnany, foreign bodies, trauma, infections, and growths
SYSTEMIC: coagulopathies. teenage girl: von Willebrand’s disease.

Answer 3

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Question 4

20% teenage girls with severe menorrhagia have a signifiant coagulation problem. a decrease in # of platelets (thrombocytopenia) can also cause abnormal bleeding.

other systemic disease such as hypothyroidism, severe liver diseases, can also cause irreg menses

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Question 5

sumubmucous fibroids most troublesome in terms of heavy bleeding. 5-10% of all fibroids

endometrial polyps can also cause bleeding, but usually not heavy.

adenomyosis (variant of endometriosis) may result in very heavy bleeding associated with menstrual cramping

endometriosis itself can cause irregular changes i nmenstrual cycle, but not typically heavy menses.

bleeding may result from cervical polyps/simple inflammation of cervix: cervicitis.

cervical polyps and cervicitis tend to present with intermenstrual bleeding/spotting after intercourse

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Question 6

85% of primary vaginal cancers are SQUAMOUS CELL CARCINOMA. most common symptoms of squamous cell cancer include vaginal bleeding/foul-smelling discharge. pain is usually a late symptom

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Question 7

vaginal bleeding after vaginal sexual activity is the most common symptom occuring in cancer of the cervix. in women with advanced disease, a foul-smelling discharge may be present

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Question 8

endometrial hyperplasia is an increased growth of the lining of the uterus and subseq thickening. most cases of endometrial hyperplasia revert to normal, either spontaneously or with hormonal treatment. most commonly older women.

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Question 9

chronic lack of ovulation (in teens), after menopause, and as a result of polycystic ovary disease, is a condotion where we may see endometrial hyperplasia

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Question 10

ENDOMETRIAL CA IS MOST COMMON MALIGNANCY OF THE FEMALE GENITAL TRACT AND ACCOUNTS FOR APPROXIMATELY 7% OF ALL CANCERS IN WOMEN.

Answer 10

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Question 11

MOST COMMON SYMPTOM OF ENDOMETRIAL CA IS ABNORMAL UTERINE BLEEDING, typically the bleeding is in form of spotting (esp in postmeno women)

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Question 12

DYSFUNCTIONAL UTERINE BLEEDING - term used after other cuases for abnormal bleeding have been excludied )fibroids, polyps, and endocrine or other disorders).

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Question 13

adolescents account for __% of DUB ater the first menstrual cycle. these are due to immature endocrine system, particularly the immature function of the hypothalamus.

Answer 13

20%

Question 14

perimenopausal women accnt for 50% due to waning ovarian function. as ovary ages, it becomes less efficient in completing the ovulatory process. initially there is a decrease in PROGESTERONE production, which causes shorter cycles. as aging process progresses, ovualtion becomes less frequent, resulting in variable length of menstrual cycle and a variation in duration of the flow. eventually, the lack of ovulation puts women in an ESTROGEN-DOMINANT state in the presence of too little progesterone because ovulation must occur in order to produce PROGESTERONE. women who are in a state of chronic anovulation tend to have an excess of estrogen in the body. this excess estrogen is what disrupts the normal pattern of menstruation

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Question 15

the remaining 30% of DUB occur in women 20-40, generally as a result of polycystic ovarian syndrome, elevated prolactin levels, emotional stress, obesity, weight loss due to anorexia, or athletic training

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Question 16

actual cause of DUB is not completely clear. theory: fluctuating estrogen levels seen in chronic lack of ovulation can cause INTERMITTENT estrogen withdrawal bleeding. another theory: continuous estrogen stimulation leads to thickening of endometrium, which needs more estrogen in order to maintain itself. eventually the need for estrogen surpasses the production and breakthrough bleeding results. another theory: some areas of endometrium outgrow their blood supply and subsequent bleeding occurs because of the lack of progesterone

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Question 17

laboratory testing for dub:
pap smear, thyroid function test, pregnancy test, CBC (r/o anemia), FSH, LH, liver function tests, prolactin levels, adrenal function studies, pelvic ultrasound to identify uterine fibroids or measure endometrial thickness, pelvic saline infusion sonohystogram, testing for STD, endometrial bx

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Question 18

if endometrial bx done at right time, it can also be used to verify OVULATION. if bx shows endometrium has proliferated, when woman’s next bleeding episode occurs within 10-12 days, it generally indicates a lack of ovulation.

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Question 19

PREVENTION: 
reduce stress
avoid taking any form of estrogen without adequate progesterone/progestins
engage in healthy lifestyle habits.
protect yourself against STD
use well-tolerated forms of contraception
have regular medical visits
maintain optimal body weight

Answer 19

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