Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Clinical Therapeutics 2 > Premenopausal and Postmenopausal Abnormal Uterine Bleeding > Flashcards

Premenopausal and Postmenopausal Abnormal Uterine Bleeding Flashcards

1
Q

what is the average length of normal menstrual bleeding?

A

5 days (range 2-7)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what is menorrhagia? what does it produce?

A

Blood loss of over 80 mL per cycle and frequently produces anemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what is normal blood loss during menstruation?

A

40mL per cycle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what is metrorrhagia?

A

bleeding b/w periods

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what is polymenorrhea?

A

bleeding that occurs more often than every 21 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what is oligomenorrhea?

A

bleeding that occurs less frequently thane very 35 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what is the mnemonic for pre-menopausla abnormal uterine bleeding causes? what’s it based on?

A

PALM-COEIN

based on etiology and bleeding pattern (heavy, light, etc.)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what does PALM-COEIN stand for?

A

mnemonic for pre-menopausla abnormal uterine bleeding causes

  • Polyp
  • Adenomyosis
  • Leiomyoma
  • Malignancy and hyperplasia
  • Coagulopathy
  • Ovulatory dysfunction
  • Endometrial
  • Iatrogenic
  • Not yet classified
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

why does abnormal uterine bleeding occur in adolescents? what does it represent in them?

A

as a result of persistent anovulation due to the immaturity of the hypothalamic-pituitary-ovarian axis

represents normal physiology

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

abnormal uterine bleeding in women ages 19-39 is often a result of?

A

Pregnancy, structural lesions, anovulatory cycles, use of hormonal contraception, endometrial hyperplasia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what should ALWAYS be r/o as a cause of abnormal uterine bleeding in reproductive age women?

A

Pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

premenopausal pts with AUB include those with what disorders?

A
  • submucosal myomas
  • infection
  • early abortion
  • thrombophilias
  • pelvic neoplasma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what herbal remedies might cause pre-menopausal AUB?

A

Black cohosh, Chamomile, Feverfew, Fish oil, Garlic, Ginger, Gingko, Ginseng

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what labs should be run for pts with pre-menopausal AUB?

A

CBC, hCG, thyroid function, coag studies, cervical samples (cytology and culture)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

who should coag studies be run on for pre-menopausal AUB?

A

for adolescents with heavy menstrual bleeding and adults with a positive screening history

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

imaging for dx of pre-menopausal AUB?

A

US, Sonohysterography or hysteroscopy, MRI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

how is US useful for pre-menopausal AUB dx?

A

useful to evaluate endometrial thickness or to diagnose intrauterine or ectopic pregnancy or adnexal masses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

how is sonohysterography or hysteroscopy useful for pre-menopausal AUB dx?

A

May be able to diagnose endometrial polyps or subserous myomas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

how is MRI useful for pre-menopausal AUB dx? is it the primary imaging modality for AUB?

A

NOT PRIMARY IMAGING MODALITY FOR AUB

Can definitively diagnose submucous myomas and adenomyosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

who should endometrial sample be performed in for AUB?

A

in pts with AUB who are older than 45 or in younger pts with h/o unopposed estrogen exposure or failed medical management and persistent AUB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what is the primary role of endometrial sampling?

A

to determine whether carcinoma or premalignant lesions are present

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

by what diagnostic procedures are polyps, endometrial hyperplasia, and sub mucous myxomas commonly identified?

A

Colposcopy, D&C, Endometrial bx, Endocervical curettage, Hysteroscopy, Saline infusion sonohysterography, Hysterosalpingography, Laparoscopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what does colposcopy visualize? use with or without? done where?

A

cervical, vaginal, or vulvar epithelium under magnification

used with and w/out dilute acetic acid

done in office

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

what areas does colposcopy identify?

A

abnormal areas requiring bx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
what is D&C?
dilation of cervix and curettage of the entire endometrial cavity
26
what does D&C do?
uses metal curette or suction cannula and forceps for removal of endometrial polls
27
endometrial bx has diagnostic accuracy similar to what other procedure?
D&C
28
what does endocervical curettage do?
removal of endocervical epithelium with small curette for dx of cervical dysplasia and cancer
29
what is hysteroscopy?
visual exam of uterine cavity with a small fiberoptic endoscope passed through cervix
30
what can be performed with hysteroscopy?
bx's and excision of myomas
31
what does saline infusion sonohysterography visualize? done what by?
puts saline into endometrial cavity to visualize sub mucous myxomas or endometrial polyps done by transvaginal US
32
what is hysterosalpingography and what does it visualize? mainly used in investigation of what?
Injection of radiopaque dye through the cervix to visualize the uterine cavity and oviducts Mainly used in investigation of infertility
33
what should be used to identify pts who require definitive therapy for pre-menopausal AUB?
hx, PE, labs, imaging, and endometrial sampling
34
what is AUB-O?
abnormal uterine bleeding ovulatory -> HPA axis is mature | vs AUB anovulatory bleeding -> HPA axis is NOT mature
35
how can AUB-O usually be treated?
hormonally - with Progestins
36
what do Progestins do normally and in terms of treating AUB-O?
limit and stabilize endometrial growth
37
what is the tx for AUB-O pts with irregular or light bleeding? what occurs with these ex's?
Medroxyprogesterone acetate x 10days Norethindrone acetate x 10 days withdrawal bleeding (medical curettage) will occur
38
if Medroxyprogesterone or Norethindrone are successful in tx for AUB-O pts can they be repeated? start meds when? when can they be reinstituted?
Yes, they can be repeated if successful for several cycles starting med on day 15 of subsequent cycles or can be reinstituted if amenorrhea or dysfunctional bleeding recurs
39
tx of AUB-O pts with heavier bleeding? how often taken? what about after withdrawal bleeding occurs?
any of the COC's -> with 30-35mcg of estrogen estradiol 4x daily for 1 or 2 days followed by 2 pills daily through day 5 and then one pill daily thru day 20 after withdrawal bleeding occurs, pills are taken in the usual doses for 3 cycles
40
tx of AUB-O pts with intractable heavy bleeding?
GnRH agonist - Depot leuprolide (IM monthly) - Nafarelin (intranasally BID) - can be used up to 6 months for ovarian suppression
41
what do the GnRH agonist medications for tx of AUB-O pts with intractable heavy bleeding require?
2-4 weeks to down regulate the pituitary and stop bleeding and will not stop bleeding acutely
42
how do you treat AUB-O with heavy bleeding requiring hospitalization? what will these meds do?
IV conjugated estrogen - every 4hrs for 3-4 doses Followed by: ethanol estradiol PO daily for 3 weeks -give with medroxyprogesterone acetate PO daily for last 10 days of tx or give COC daily for 3 weeks these will thicken the endometrium and control the bleeding
43
what will NSAIDs do?
reduce blood loss menorrhagia
44
if the abnormal uterine bleeding is NOT controlled by hormonal tx what do you do? what structural lesions?
hysteroscopy with tissue sampling or saline infusion sonohysterography to evaluate for structural lesions -polyps, sub mucous myxomas, neoplasms
45
if AUB is not controlled by hormonal tx and thee is no specific pathology, what are tx choices?
Endometrial ablation Levonorgestrel-releasing IUD Hysterectomy
46
endometrial ablation can be performed through?
hysteroscope with laser photocoagulation or electrocautery
47
endometrial ablation non-hysteroscopic techniques (outpatient) can be performed through?
- Balloon thermal ablation - Cryoablation - Free-fluid thermal ablation - Impedence bipolar radiofrequency ablation - Microwave ablation
48
what does Levonorgestrel-releasing IUD do?
markedly reduces menstrual blood loss
49
how many pts will need endometrial ablation repeat after 5 years?
40%
50
is hysterectomy common nowadays?
NO!!! UNCOMMON
51
when do you refer a pt with pre-menopausal AUB?
- If bleeding is not controlled with first line therapy | - If expertise is needed for a surgical procedure
52
when do you admit a pt with pre-menopausal AUB?
- If bleeding is uncontrolled with first-line therapy | - Hemodynamically unstable
53
what is post-menopausal abnormal uterine bleeding? this type of bleeding needs to be what?
Vaginal bleeding that occurs 6 months or more following cessation of menstrual function NEEDS TO BE INVESTIGATED!!!
54
most common causes of post-menopausal AUB?
- Atrophic endometrium/vaginal - Endometrial proliferation - Hyperplasia, endometrial or cervical cancer - Administration of estrogens with or without added progestin - Endometrial polyps
55
what is the MAIN imaging to dx postmenopausal bleeding?
Transvaginal US
56
wha should you inspect and for what to dx postmenopausal bleeding?
vulva and vagina for areas of bleeding ulcers, or neoplasms
57
what smear should be done for dx of postmenopausal bleeding?
cytologic smear of the cervix and vaginal pool
58
what does transvaginal US measure?
endometrial thickness
59
endometrial thickness measurement of 4mm or less indicates what for postmenopausal bleeding?
low likelihood of hyperplasia or endometrial cancer
60
endometrial thickness >4mm or heterogeneous appearance to the endometrium means what for post-menopausal bleeding?
need to determine if the thickening is global or focal
61
when'd o you need to determine if the thickening of the endometrium is global or focal?
when endometrial thickness >4mm or heterogeneous appearance to the endometrium
62
what assists in making distinction of global or focal endometrial thickening?
sonohysterography
63
if the thickening of the endometrium is global, then do what?
endometrial bx or D&C
64
if the thickening of the endometrium is focal, then dow hat?
sampling with hysteroscopy
65
what is the tx for endometrial hyperplasia?
cyclic or continuous progestin therapy -medroxyprogesterone acetate daily PO for 21 or 30 days for 3 months OR -norethindrone acetate daily PO for 21 or 30 days for 3 months
66
what is another tx option for endometrial hyperplasia besides cyclic or continuous progestin therapy?
levonorgestrel intrauterine system
67
if symptoms of post-menopausal bleeding recur after tx, what should be performed?
repeat sampling
68
if endometrial hyperplasia with atypic or if carcinoma of the endometrium is found, what is NECESSARY?
HYSTERECTOMY
69
when do you refer pt with post-menopausal bleeding?
- Expertise in performing ultrasonography is required - Complex endometrial hyperplasia with atypia is present - Hysteroscopy is indicated
70
is neonatal vaginal bleeding normal? does it require tx? is it self-limited?
yes, if it lasts <1 week -it's self-limited and requires no tx
71
what is neonatal vaginal bleeding caused by?
withdrawal of hormones the baby was exposed to in the womb
72
what is the tx for symptomatic endometrial polyps?
more likely to be malignant so must be removed
73
what is the tx for endometrial polyps in postmenopausal women?
always remove the polyp b/c risk of malignancy is high whether symptoms or asymptomatic
74
what is AUB?
bleeding from the uterus that differs in frequency, regularity, duration, or amount from normal uterine bleeding in the absence of pregnancy
75
non-gynecologic etiologic sx's for AUB?
changes in bowel movements or urination
76
infectious etiologic sx's for AUB?
suprapubic/lower abdominal pain, vaginal discharge, fever
77
metabolic etiologies sx's for AUB?
hot flashes, hirsutism, hair loss, acne
78
CNS etiology sx's for AUB?
HA, breast discharge
79
what is important for the workup in 8 year olds? - young age group. what do you inspect? what do you not use for inspection of the vaginal vault?
physical exam -if general exam and inspection of external genitalia don't elicit a dx, inspect vaginal vault but NOT with a speculum
80
what is mild anovulatory uterine bleeding?
longer than normal menses (>7 days) or shortened cycles (<24 days) for at least 2 months with slightly or moderately increased menstrual flow
81
what is moderate anovulatory uterine bleeding?
moderately prolonged (>7 days) or frequent menses (every 1-3 weeks) with moderate to heavy menstrual flow and hemoglobin at least 10g/dL
82
what is severe anovulatory uterine bleeding?
disruptive menstrual cycles with heavy bleeding with Hgb <10g/dL may or may not cause hemodynamic instability
83
tx for anovulatory bleeding?
menstrual calendar, observation and reassurance vs. hormonal therapy Iron 60mg PO QD
84
when do you follow-up for anovulatory bleeding?
in 3-6 months unless bleeding becomes more severe
85
what is the first thing to rule out if pt is having postcoital bleeding?
malignancy
86
what is postmenopausal bleeding?
any uterine bleeding in a menopausal woman other than expected cyclic bleeding that occurs in women making cyclical postmenopausal hormone therapy
87
all postmenopausal women with unexpected uterine bleeding, should be evaluated for what?
for endometrial carcinoma

Clinical Therapeutics 2 (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions