Normal and Abnormal Uterine Bleeding Flashcards
What is abnormal uterine bleeding (AUB)?
AUB refers to any uterine bleeding considered irregular in amount, frequency, duration, or timing, as judged by the woman or clinician.
What is the physiological basis of normal uterine bleeding?
Controlled by the hypothalamic–pituitary–ovarian axis (HPOA).
Hormonal events lead to ovulation, and if conception does not occur, menses follows.
Progesterone withdrawal causes PGF2 alpha production, leading to dysmenorrhea.
What does the PALM-COEIN classification stand for?
PALM (Structural causes):
Polyp, Adenomyosis, Leiomyoma, Malignancy/Hyperplasia.
COEIN (Nonstructural causes): Coagulopathy, Ovulatory dysfunction, Endometrial, Iatrogenic, Not otherwise classified.
What are examples of structural causes of AUB?
Polyps (AUB-P): Growths on the cervix or endometrium.
Adenomyosis (AUB-A): Endometrial tissue within the myometrium.
Leiomyomas (AUB-L): Benign fibroids in the myometrium.
Malignancy/Hyperplasia (AUB-M): Common symptom of endometrial cancer.
What are examples of nonstructural causes of AUB?
Coagulopathy (AUB-C):
Clotting disorders.
Ovulatory Dysfunction
(AUB-O): Includes anovulation and amenorrhea.
Endometrial (AUB-E): Related to the uterine lining.
Iatrogenic (AUB-I): Medication-induced. Not otherwise classified
(AUB-N): Unclear causes.
What subjective information should be gathered when evaluating AUB?
Age at menarche/menopause, cycle length, duration, flow, and changes in pattern. Contraceptive type, duration, and side effects. Complete medical and medication history.
What diagnostic tests are used to evaluate AUB?
Pregnancy test, CBC, TSH, prolactin, Papanicolaou test, NAAT, coagulation studies, serum progesterone. Imaging: Transvaginal ultrasound (TVS), endometrial biopsy, pelvic sonography, hysteroscopy, MRI, and CT.
What are the goals of treating AUB?
Normalize bleeding. Correct anemia. Prevent cancer. Restore quality of life.
What pharmacologic options are available for acute, non-life-threatening heavy menstrual bleeding (HMB)?
Estrogen therapy. Combined oral contraceptives (COCs). Progestogen therapy. Gonadotropin-releasing hormone agonists (GnRHas).
What nonhormonal pharmacologic treatments exist for HMB?
NSAIDs. Tranexamic acid (Lysteda): An antifibrinolytic agent reducing menstrual bleeding by 45%–60%.
What surgical options are available for HMB?
Endometrial ablation. Uterine artery embolization. Hysterectomy.
What are common causes of amenorrhea?
Primary amenorrhea: Anatomical abnormalities, genetic disorders.
Secondary amenorrhea: Anovulation, ovarian failure, thyroid disease, hyperprolactinemia, functional amenorrhea (underweight, over-exercised, stressed).
What tests help diagnose amenorrhea?
Bimanual exam (for outflow tract abnormalities). Lab tests: Estrogen production, FSH levels, TSH, prolactin. Imaging: MRI (for hypogonadism or hyperprolactinemia).
What are special considerations for adolescents with AUB?
Menstrual cycle as a vital sign of health. Pelvic exam only if indicated. Common treatments: medical therapy and nutrition counseling.
How does AUB management differ in perimenopause?
Educate women on incidence of AUB during menopause. Encourage regular exercise, iron/calcium supplementation, and smoking cessation.
