Normal/Abnormal uterine bleeding Flashcards
normal cycle interval is how many days?
21-38 days
normal duration of flow
4.5-8 days
normal amount of flow (in cc total)
5-80cc
moliminal
PMS symptoms
What increases which causes PMS symptoms?
progestrone
acute uterine bleeding
any episode in nonpregnant, reproductive woman who has sufficient bleeding
chronic uterine bleeding
bleeding present for 6 months or longer, abnormal in duration, volume and frequency
heavy menstrual bleeding
blood loss that interferes with the physical, emotional, social, quality of life and that can occur alone or in combination with other symptoms
prolonged menstrual bleeding
bleeding longer than 8 days
shortened menstrual bleeding
bleeding shorter than 2 days
light menstrual bleeding
reduced volume of bleeding from normal
intermenstrual bleeding
bleeding that occurs between menstrual cycles. can be cyclic and predictable or follow no particular pattern
PALM (classification for abnormal uterine bleeding)
Polys
Adenomyosis
Leiomyoma (at least 1 submuccosal myoma)
Malignancy and hyperplasia
PALM refers to what kind of abnormalities?
structural
COEIN refers structural or nonstructural abnormalities?
nonstructural abnormalities
COEIN
Coagulopathy Ovulatory Dysfunction Endometrial Iatrogenic Not yet classified
Malignancy/Hyperplasia are rare in which types of women?
reproductive aged women, women with normal BMI
Which women are more at risk for Malignancy/Hyperplasia
obese, PCOS, African
COEIN: Ovulatory disfunction includes which type of abnormal uterine bleeding?
Ovulatory, anovulatory and amenorrhea
when does Ovulatory disfunction occur and is bleeding cyclic, noncylic? PMS symptoms?
occurs in peak reproductive years (period is already established), bleeding is cyclic, PMS symptoms present
when does anovulatory dysfunction occur and is it cyclic, noncyclic? PMS symptoms?
occurs more towards end of reproductive age, noncyclic intervals, no PMS symptoms
what underlying problems can cause ovulatory disfunction?
Thyroid issues, PCOS, excessive exercise, mental distress
what underlying problems can cause anovulatory disfunction?
endometrial hyperplasia, lack of progrestrone in luteal phase (which leads to unstable endometrium)
when is the best time to do a transvaginal US
day4-6 of menstraul cycle
Sonohystogram
uses NS to visualize uterus better
When do you do an Endometrial biopsy if >35 years old
uterine lining >4mm OR any abnormal bleeding.
When do you do an Endometrial biopsy if <35 years old
morbid obesity, hx PCOS, chronic anovulation, if they take tamoxifen or at risk for endometrial ca
which drugs help suppress the endometrium?
Depo, OC, merina IUD
Tranexamic acid (Lysteda) and dosage
drug used to decrease prostaglandins in the uterus. The uterus comes out all at once rather than in pieces. take 2 tabs TIDx5 days
Tranexamic acid (Lysteda) puts you at risk for?
blood clots
how to correct prostaglandin imbalances?
NSAIDS, start first day of menses x3 days
can start 24 hours prior
D and C vs endometrial ablation
D and C=mowing the grass, endometrial ablation=dig out the roots
risk factors for endometrial ca
> =40 years old, anovulation, PCOS, bleeding after menopause, nulliparity, overweight, tamoxifen therapy,endometrial lining >4mm
secondary amenorrhea
no menses for 3 previous cycles OR 6 months total
primary amenorrhea
no menses by 14 AND absence of growth or development of secondary sexual characteristics
no menses by 16 regardless of sexualcharacteristics
disorders that can lead to amenorrhea involve which organs?
uterus
ovaries
pituitary
hypothalmus
primary amenorrhea causes
congenital malformations, testicular feminization, lower genital tract problems, hypergonadism, ovarian enzyme disorder
secondary amenorrhea causes
ashermans syndrome (scarring from D and C), cervical stenosis, OC, hyperthyroidism/hypo, PCOS, pituitary tumor
which meds can cause amenorrhea (secondary or primary)
Antipsychotics, cancer chemo, antidepressants, BP drugs, allergy meds
Endometrial uterine bleeding is cyclic? noncyclic?
predictive, cyclic, heavy bleeding, may have intermenstraul bleeding