GYN: Abnormal Uterine Bleeding Flashcards
Cut-of frequency, regularity, duration, and volume of normal menstruation
Frequency: every 24-38 days
Regularity: (+/-) 2 to 20 days
Lasting 4.5 to 8 days
Volume: 5 to 80mL
Chronic AUB is defined as ____ month wherein majority of the symptoms are present
6 months
____ are risk factor for AUB-Polyp
- Tamoxifen use
- Infertility
- HRT (estrogen-only and combined)
Hypothesis of the development of AUB-A
- Increase in endometrial surface
- Altered PGE/PGF2a balance
- Hampered myometrial contractility
- Abnormal myometrial angiogenesis associated with fragile
Pathophysiology og AUB-L
- Increased surface area of the endometrium due to mechanical distortion
- Ulceration and hemorrhage of endometrium overlying the submucous fibroids
- Interference by the myomas with the normal uterine hemostasis
- Mechanical compression of the venous drainage by the myomas at any site
- Dilatation of the venous plexus draining the endometrium
What is the FIGo classification of a myoma where it contacts the endometrium and 100% intramural
FIGO 3
FIGO 4 - intramural
FIGO 5 - subserosal >= 50%, intra mural
FIGO 6 - subserosal < 50% untramural
What is the normal menstrual cycle length?
28 +/- 7 days
What is the normal duration of flow in each menstrual cycle?
4 days
but can go up to 7 days
What is the normal menstrual blood flow loss
35mL average
55 to 60mL
What is the average iron loss per menses?
16mg
What are the components of endometrial polyp
- Endometrial gland
2 Endometrial stroma - Central vascular channels
What are the possible causes of endometrial polyp?
Estrogen stimulation
[AUB-L]
<50% intramural
SM 1
[AUB-L]
> / 50% intramural
SM2
[AUB-L]
contacts endometrium, 100% intramural
O3
[AUB-L]
intramural
O4
[AUB-L]
subserosal >/50% intramural
O5
[AUB-L]
subserosal <50% intramural
O6
[AUB-L]
Subserosal peduculated
O7
What is the most common presenting symptom of endometrial cancer?
AUB
AUB O is due to ____
alterations in neuroendocrine function
What is the first line diagnostic tool for AUB?
UTZ
What is an accurate diagnostic tool for intracavitary lesions?
SIS
What are the indications of endometrial biopsy in patients with AUB?
- Postmenopausal woman with bleeding
- Premenopausal woman with heavy or irregular vaginal bleeding
- Postmenopausal woman with endometrial cells
- Premenopausal woman with atypical glandular cells
- Breast CA patients in Tamoxifen who complains of abnormal vaginal bleeding
- Women who are still menstruating after 52 years of age
___ is a diagnostic and therapeutic procedure for AUB in patients who are actively bleeding
Endometrial curettage
___ is an androgenic drug used to treat AUB
Danazol 200mg and 400mg daily given over 12 weeks
inhibits gonadotropins
What is the role of estrogen in the treatment of AUB?
- Rapid growth of endometrium
2. Promote platelet adhesiveness
What is the role of progestogens in treating AUB?
- Decrease synthesis of estrogen receptors
- Stops EM growth
- Support and organize the endometrium
- Arachidonic acid formation to increase PGF2alpha/PGE ratio
What are the side effects of Danazol?
- Weight gain
2. Acne
____ is a GNRH agonist that suppresses gonadotrope secretion of luteinizing hormone and follicle-stimulatinghormone
Leuprolide
What is the treatment of choice in women with hypovolemia due to DUB?
D and C
What is the initial treatment for HMB?
Endometrial ablation
