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Jason's MD3 Women's > Heavy Menstrual Bleeding > Flashcards

Heavy Menstrual Bleeding Flashcards

1
Q

Heavy Mentrual Bleeding?

A

Guided by patient perceived problem

Usually >80ml per cycle

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2
Q

Causes of vaginal bleeding, don’t ever forget?

A

Pregnancy

Trauma

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3
Q

PALM-COIEN Classification

A

Palm - structural

COEIN -

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4
Q

Polyps are?

A

Usually asymptomatic

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5
Q

Adenomyosis is?

A

Endometrial glands within myometrium

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6
Q

When Adenomyosis?

A

Late 30s and 40s

Large bulky uterus

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7
Q

Fibroids during preg?

A

May grow in response with hormones

May obstruct delivery

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8
Q

Heavy bleeding Rx?

A
  • Suppress the endometrium

- hormones usually.

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9
Q

PALM COEIN

A 
Polyps
Adenomyosis
Leiomyoma 
Malignancy
-
Coagulopathy
Ovulatory Dysfunction
Endometrial
Iatrogenic
Not yet Classified
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10
Q

COEIN is?

A

Nonstructural causes of HMB

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11
Q

What is the constant phase in menstrual cycle?

A

LuteaL phase (14 days)

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12
Q

Endometrial dysfunction, why?

A

Popular: too much prostacyclin

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13
Q

Ovulatory dysfunction?

A

Long irregular, no ovulation, no signal to menstruate

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14
Q

Consequences of ovulatory dysfunction?

A

Subfertility

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15
Q

Endocrine causes?

A

Thyroid
Pituitary or adrenal disease
PCOS - hormone variation, lifestyle
Weight changes - loss, or gain

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16
Q

Break through bleeding with COC why?

A

Pill causes lining to be too thin.

Or incomplete suppression of HPO axis

17
Q

Other reasons for bleeing?

A

Endometriosis

18
Q

Most common reason for pain with menstruation

A

Prostaglandin related

19
Q

Smears and constant bleeding?

A

Pap smear in case it’s cervical cancer

Do a thin prep

20
Q

Ix for HMB?m

A 
Iron studies
BHCG
FBE
Coags
Bleeding profile?
TFTs
FSH, LH, estradiol, androgen screen (PCOS)
21
Q

Imaging for HMB?

A

U/S

22
Q

What is pipelle?

A

Small suction device, goes through cervix to take endometrial sample

23
Q

What is gold standard for endometrial sampling?

A

Hysteroscopy D&C

Distended with saline/C02

24
Q

When do endometrial sampling?

Transvaginal U/S and Pipelle?

A

Woman >40 with HMB

Or post menopausal bleeding

25
Q

Best way to turn off periods?

A

Monophasic pills, same dosage and skip sugar pills

26
Q

Total hysterectomy is?

A

Including cervix

27
Q

Special scenarios?

A

Teenagers
Vitals
Can decompensate quickly if heavy blood loss

28
Q

Which type of fibroid is most likely to cause heavy bleeding?

A

Su mucosal

29
Q

Which type of fibroid is most likely to cause heavy bleeding?

A

Su mucosal

Jason's MD3 Women's (58 decks)

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