Lecture 23: Abnormal Bleeding CPC

Question 1

What is normal bleeding?

Answer 1

1. Frequency is 24-35 days
2. 4-7 days
3. 30 ml

Question 2

What is anovulatory bleeding?

Answer 2

Unopposed estrogen
Dysynchronous shedding
Watch out for patients who refer to vaginal bleeding as “menstruation”

Question 3

What are the DDx of abnormal bleeding?

Answer 3

PALM-COEIN
PALM = related to uterine STRUCTURAL abnormalities
COEIN = NON-STRUCTURAL
Polyp
Adenomyosis
Leiomyoma
Malignancy and Hyperplasia

Coagulopathy
Ovulatory dysfunction
Endometrial
Iatrogenic
Not yet classified

Question 4

What is Pfiefer’s DDx of abnormal uterine bleeding?

Answer 4

1. Structural
   i. uterine
   ii. cervical
   iii. vaginal
2. Hormonal
   i. ovarian
   ii. hormonal

Question 5

What does regular periods suggest to you?

Answer 5

It is NOT a hormonal issue

Normal cycles but excessive bleeding = STRUCTURAL

Question 6

What is the first thing you need to rule out in women of reproductive age?

Answer 6

Pregnancy

Question 7

When a woman is postmenopausal and has vaginal bleeding, what must you rule out first?

Answer 7

Cancer

Question 8

What is the best treatment for endometrial hyperplasia?

Answer 8

Progesterone
This makes it so that you take the woman from proliferative (follicular) phase in endometrium and change it to secretory (luteal) phase

Question 9

When you have a large endometrial stripe, what may you be afraid of?

Answer 9

Mammogram

Cancer