DUB/AUB + Dysmenorrhea

Question 1

what is AUB?

Answer 1

abnormal uterine bleeding in non-pregnant woman that is a departure from regular flow, duration, and volume

ABNORMAL FREQUENCY AND INTENSITY due to nonorganic causes

Question 2

normal cycle

Answer 2

24-38 days with mensruation that is 4.5-8 days (30mL of blood loss - <80mL)

Question 3

amenorrhea

Answer 3

absence of period

Question 4

cryptomenorrhea

Answer 4

light flow/spotting

Question 5

menorrhagia

Answer 5

heavy or prolonged bleeding at normal menstrual intervals

Question 6

menorrhagia

Answer 6

irregular, excessive bleeding between expected menstrual cycles

Question 7

menometrorrhagia

Answer 7

irregular excessive bleeding between cycles

Question 8

oligomenorrhea

Answer 8

infrequent menstruation (>35 days but less than 6 mo)

Question 9

polymenorrhagia

Answer 9

menstruation < 21 days apart

Question 10

patho of anovulation and DUB

Answer 10

unopposed estrogen = no progesterone so endometrial overgrowth occurs

Question 11

patho of ovulatory DOB

Answer 11

regular shedding with prolonged progesterone secretion = blood loss from endometrial vessel dilation and PROSTAGLANDINS

Question 12

w/u shows NO evidence of organic cause and NEGATIVE pelvic exam

Answer 12

DUB

Question 13

structural causes of DUB

Answer 13

PALM

Polyp
Adenomyosis
Leiomyoma
Malignancy and hyperplasia

Question 14

non structural causes of DUB

Answer 14

COEIN

Coagulopathy
Ovulatory dysfuncitn 
Endometrial 
Iatrogenic 
Not otherwise classified

Question 15

DUB + 35 w/u

Answer 15

must do an endometrial biopsy on 35 with obesity, HTN, DM or after menopause to r/o cancer

Question 16

management of DUB with active bleeding

Answer 16

high dose IV estrogen or high dose OCP

can do D and C

Question 17

management of DUB - medicinal

Answer 17

OCP first line (regulates cycle, thins lining, reduces flow)

progesterone only (if estrogen CI) - IUD

GnRH agonists

Question 18

when do we do surgery for DUB

Answer 18

refractory

can do hysterectomy or endometrial ablation

Question 19

painful menstruation that affects nml activity

Answer 19

dysmenorrhea

Question 20

primary dysmenorrhea

Answer 20

not due to pelvic pathology

DUE TO PROSTAGLANDINS = painful wall activity

Question 21

onset of primary dysmenorrhea

Answer 21

1-2 years after menarche (teens)

Question 22

secondary dysmenorrhea causes

Answer 22

pelvic pathology

endometriosis, adenomyosis, leomyoma, PID, adhesions

Question 23

onset of secondary dysmenorrhea

Answer 23

incidence increase with age

> 25

Question 24

manifestations of dysmenorrhea

Answer 24

pelvic pain right before or with the onset of menses (can radiate to lower back and legs)

associated with HA, n/v, lasts 1-3 days

Question 25

MC cause of secondary dysmenorrhea

Answer 25

young: endometriosis
old: adenomyosis

Question 26

treatment of dysmenorrhea

Answer 26

1. NSAIDS (first line)
2. ovulation suppression (OCPs*, depo, vaginal ring)
3. laparoscopy

Question 27

NSAIDS dysmenorrhea

Answer 27

inhibition of prostaglandin mediated uterine activity

start before onset of symptoms and take 2-3 days

Question 28

what levels elevated in primary dysmenorrhea

Answer 28

prostaglandins, leukotrienes

Question 29

what symptoms might clue you in to secondary dysmenorrhea

Answer 29

bloating
heavy bleeding
dyspareunia

less related to start of flow