Module 5 Study Guide Flashcards
What symptoms are associated with AUB-P (polyps)?
Light bleeding between periods and bleeding after sex
What type of patient is more likely to have AUB-A (adenomyosis)?
Multip >40
What is the most likely cause of structural AUB?
Leiomyoma (fibroid)
A patient presents with sudden change is bleeding. What should we be most concerned for?
Malignancy and hyperplasia
Your postmenopausal patient presents to the office for bleeding. What is our biggest concern/differential?
Malignancy and hyperplasia
Why do adolescents and perimenopausal patients often have AUB? Is it normal?
Irregular ovulation. It is often normal
At what point after menarche would we start to be concerned about AUB?
After 2-3 years. Before then, the HPO axis is immature and ovulation is irregular
What type of bleeding is associated with adenomyosis?
Menorrhagia-bleeding >7 days
A teen presents with heavy bleeding, what should we assess for?
Physical exam annd ROS for coagulopathy. Referal and/or labs as needed
A patient presents for bleeding between periods. What should we assess for?
STDs, infection (endometritis) and polyps
Your patient presents with AUB, sleep disturbances and temp. intolerance. What is your primary differential?
Thyroid disorder
Your patient presents with AUB, headaches and galactorrhea. What is are your primary differentials?
Prolactin secreting tumor or hypothyroidism
You prescribe COC to a patient with prolonged menstrual bleeding. What should you educate them to return for evaluation for?
Bleeding that does not stop within 48 hours
When should we evaluate a teen for primary amenorrhea secondary sex characteristics absent or present?
-Absence=14 y/o
-Present=16 y/o
Evaluate anyone who has not reached menarche by 15 or who have not had a menses w/in 3 years of thelarche
When should we investigate secondary amenorrhea?
No menses for 3 cycles or 6 months, whichever occurs first
How should you assess a patient with primary amenorrhea without secondary sex characteristics?
Measure FSH and LH levels
How should you assess a patient with primary amenorrhea with secondary sex characteristics?
Perform ultrasonography of the uterus. If uterus present, check for outflow obstruction. If not present, check genetics
What initial labs should be done on someone with secondary amenorrhea?
Pregnancy test-if negative then:
-TSH and prolactin
What should you do if your patient with secondary amenorrhea has a negative pregnancy test and normal TSH and prolactin levels?
A progestin challenge test
What does it mean if the patient has withdrawal bleeding when given a progestin challenge test?
Estrogen is present and they do not have an outflow tract obstruction
List causes of secondary amenorrhea.
Pregnancy
Asherman syndrome
Cervical stenosis
Hormonal contraception
Thyroid disorder
PCOS
Pituitary tumor
Premature ovarian failure
Menopause
Hypothalamic/CNS disorders
Describe the progestin challenge tests and its results.
Progestin is given for 7-10 days. Bleeding only occurs if sufficient circulating estrogen and a patent outflow tract exist. Bleeding should occur within 7-10d of completion of progesterone.
Bleeding is considered a positive result
If PCT is given and pt experiences withdrawal bleeding, what conditions are still included as differentials?
-PCOS - withdrawal bleed
-Excess adipose tissue - withdrawal bleed - estrogen produced in part by adipose tissue
If PCT is given and pt doe not experience withdrawal bleeding, what conditions are still included as differentials?
Galactorrhea - no withdrawal bleed - prolactin high → low estrogen
Prolactinoma - no withdrawal bleed, high prolactin → inhibited estrogen
Ovarian insufficiency - no withdrawal bleed - ovaries d/n produce estrogen
