Normal and Abnormal Uterine Bleeding

Question 1

what type of endometrium do pts with anovulatory bleeding have predominantly from unopposed stimulation by estrogen?

Answer 1

proliferative endometrium

Question 2

What do progestins do to the endometrium?

Answer 2

inhibit further endometrial growth, converting proliferative to secretory endometrium

Question 3

What does withdrawal of progestin do?

Answer 3

mimics effect of involution of corpus luteum, creating normal sloughing of the endometrium

Question 4

What is management of endometrial polyps?

Answer 4

includes observation, medical management with progestin, curettage, surgical removal(polypectomy) via hysteroscopy and hysterectomy. observation not recommended in polyp>1.5cm.

Question 5

What are the hormone abnormalities in PCOS?

Answer 5

testosterone levels at upper limits of normal or slightly increased. Free testosterone is elevated often because sex hormone binding globulin is decreased by elevated androgens. LH is increased in a pulsatile manner which causes increased ovarian androgen production by the theca cells of the ovary. Insulin resistance and chronic anovulation are hallmarks of PCOS.

Question 6

What does PALM-COEIN stand for in differential dx in abnormal uterine bleeding?

Answer 6

polyp, adenomyosis, leiomyoma, malignancy, coagulopathy, ovulatory dysfunction, endometrial, iatrogenic, not classified

Question 7

what is mid cycle bleeding?

Answer 7

bleeding at time of ovulation due to drop in estrogen

Question 8

What are transplant patients at risk for?

Answer 8

cervical dysplasia or cancer because of rejection meds that weaken immune system