S11C99 - Vaginal Bleeding in the nonpregnant pt

Question 1

4 phases of menstrual cycle:

Answer 1

• menses
• follicular
• ovulation
• luteal (secretory)

Question 2

postmenopausal bleeding defn

Answer 2

-any bleeding tha toccurs more than 6mo after cessation of menstruation

Question 3

Organic cause of uterine bleeding: DUB

Answer 3

• ovulatory

- anovulatory

Question 4

Organic cause of uterine bleeding: Neoplastic

Answer 4

• vulva/vaginal
• cervix, polyps
• fallopian tube
• ovary
• uterus: myoma, leiomyoma (Fibroid), adenomyoma, polyp

Question 5

Organic cause of uterine bleeding: Ectopic tissue

Answer 5

• endometriosis

- adenomyosis

Question 6

Organic cause of uterine bleeding: Inflammatory/infxs

Answer 6

• vulvitis, vaginitis
• cervicitis, erosions
• endometritis
• PID

Question 7

Organic cause of uterine bleeding: traumatic or FB

Answer 7

-

Question 8

Organic cause of uterine bleeding: systemic

Answer 8

• coagulopathy
• blood dyscrasia
• endocrinopathy (hypothyroid)
• liver dz
• pituitary tumor
• drugs (antiseizure meds)

-eating d/o, exercise excess, stress, wt loss

Question 9

Organic cause of uterine bleeding: reproductive tract dz

Answer 9

-pregnancy - ectopic

Question 10

Short-term medical mgmt of hemodynamically stable uterine bleeding:

Answer 10

-estrogen tx: conjugated estrogen (premarin) 10mg/d PO(2.5mg QID) or 25mg IV every 2-4h for 24h
once bleeding subsides, add medroxyprogesterone actate (provera) 10mg/d
continue both for 7-10d then stop for w/d bleed

-OCP: ethinyl estradiol 35mcg and norethindrone 1mg
four tabs x7d
or 4 tabs x2d, then 3 tabs x2d, then 2 tabs x2d, then 1 tab x3d

• progesterone: provera 10mg x10d for persistent light bleeding assoc with anovulation
• TXA 0.3-1g PO q8h x3d

Question 11

Diagnoses of uterine bleeding to be r/o in ED:

Answer 11

• pregnancy
• FB
• trauma
• bleeding dyscrasia
• infection

Question 12

DUB: long-term mgmt

Answer 12

• OCP decreases menorrhagia by 50%
• NSAID decrease bleeding by 20-50%, start on day 1 of period and continue until bleeding stops (not as useful for fibroids)
• IUD
• txa
• clomiphene citrate
• endometrail ablation
• hysterectomy

Question 13

Uterine bleeding in pts with blood dyscrasias

Answer 13

• OCP
• DDAVP (Simulates endogenous release of factor VIII and vWF)
• dont’ give NSAIDS!!