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Bloc I - Reproduction > Sept5 A1-Abnormal_uterine_bleeding > Flashcards

Sept5 A1-Abnormal_uterine_bleeding Flashcards

1
Q

menorrhagia def

A

prolonged duration of cycle and excessive flow (>7 days, >80 ml of blood)

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2
Q

metrorrhagia def

A

irregular cycles or bleeding between periods

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3
Q

menometrorrhagia def

A

frequent menstrual bleeding that is excessive and irregular in amount and duration (mix of metro and menorrhagia)

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4
Q

hypermenorrhea def

A

regular cycles, normal duration, excessive flow**

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5
Q

polymenorrhea def

A

frequent** menstrual bleeding (cycle less than 21 days)

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6
Q

oligomenorrhea def

A

infrequent cycles (<8 per year)

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7
Q

dysmenorrhea def

A

painful period

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8
Q

definition of abnormal uterine bleeding

A

heavy menstrual bleeding or intermenstrual bleeding. so includes

  • menorrhagia (abnormal duration and amount)
  • metrorrhagia (irregular)
  • menometrorrhagia (irregular + abnormal duration and amount)
  • hypermenorrhea (abnormal amount)
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9
Q

FIGO classif of causes of AUB

A
  • PALM
  • COEIN
  • pregnancy
  • infection
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10
Q

PALM part of FIGO classif of AUB causes

A

are structural causes

  • polyp
  • adenomyosis
  • leiomyoma
  • malignancy and hyperplasia
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11
Q

COEIN part of FIGO classif of AUB causes

A

non structural causes

  • coagulopathy
  • ovulatory dysfunction
  • endometrial (prob of clotting (hemostasis) locally)
  • iatrogenic
  • not yet classified
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12
Q

how pregnancy can cause AUB

A
  • implantation
  • abortion
  • ectopic pregnancy
  • gestational trophoblastic disease
  • postpartum infection
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13
Q

how infection can cause AUB

A
  • STD
  • TB
  • chronic endometritis
  • postabortal or postpartum infection
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14
Q

imp hx steps in AUB

A
  • anemia sx
  • cervical cancer screen
  • dysmenorrhea
  • pelvic pain, pressure
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15
Q

imp PE steps in AUB

A
  • abdo exam to palpate fibroids
  • bimanual exam to feel pelvic masses, fibroids, etc.
  • thyroid exam
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16
Q

imp lab studies in AUB

A
  • CBC
  • bHCG (pregnancy)
  • TSH (hypo or hyperT)
  • PT, PTT and bleeding
  • PCOS and CAH investigations
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17
Q

imp imaging study in AUB

A

ultrasound

  • PCOS
  • fibroids, adenomyosis
  • endometrial stripes (to eval thickness)
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18
Q

endometrial polyps sx

A
  • intermenstrual bleeding
  • irregular bleeding
  • menorrhagia
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19
Q

cervical polyps sx

A
  • intermenstrual spotting

- postcoital spotting

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20
Q

main way to dx endometrial polyp

A

pelvic US

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21
Q

when to treat endometrial polyps

A
  • sx
  • risk factors for malignant transformation (including tamoxifen use)
  • tx is surgery*
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22
Q

tamoxifen is what

A
  • breast cancer med
  • selective estrogen R modulators
  • negative effect on estrogen R in breast but positive effect o ERs in uterus
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23
Q

adenomyosis def

A

ectopic rests of endometrium in the myometrium

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24
Q

sx of adenomyosis

A
  • menorrhagia
  • dysmenorrhea
  • large uterus, no fibroids
25
Q

dx of adenomyosis

A
  • clincally

- US

26
Q

when to tx adenomyosis

A

only if sx. tx = manage pain and bleeding

  • NSAID for pain
  • COC (E and P OCP), progesterone only contraceptive
  • LNG-IUS
  • GnRH agonist
  • hysterectomy
27
Q

LNG-IUS is what

A

Mirena IUD (progesterone).

  • progesterone has an anti-mitogenic effect in the endometrium
  • cause of dysmenorrhea is accum of blood in pockets of glands in the myometrium + nowhere to go
  • P allows endometrium to become thin so can bleed
28
Q

GnRH agonist effect

A

stops period and puts you in medical menopause. acts on HPO axis

29
Q

leiomyoma (fibroids) def

A
  • benign SM neoplasm from myometrium

- each one derives from single progenitor myocyte

30
Q

most common pelvic tumor in women

A

fibroids (leiomyoma)

31
Q

leiomyoma dx

A
  • PE

- US or MRI

32
Q

diff possible locations of fibroids

A
  • pedunculated serosal or submucous
  • serosal
  • submucous
  • intramual
  • intraligamentary
  • cervical
33
Q

sx of fibroids (leiomyomas)

A
  • majority asx
  • dysmenorrhea, menorrhagia
  • pelvic pain and pressure + assoc bulk symptoms
  • infertility bc of obstruction
34
Q

when to tx fibroids

A

when sx

35
Q

tx options for fibroids (leiomyomas) depending on sx

A
  • dysmenorrhea only = NSAID
  • dysmenorrhea + menorrhagia = COC or DMPA (injected contraception) or LNG-IUS
  • dysmen + menorrh + pelvic P = ulipristal
  • dysmenorrhea + menorrhagia + pelvic P + infertility = GnRH agonist
  • anti-fibrinolytics
  • surgery
36
Q

what’s ulipristal

A

lactate progesterone R modulator. acts on prog Rs of fibroids to stop the bleeding.
-only prob = get unopposed estrogen effect in endo = thickening

37
Q

PALM: malignancy and hyperplasia def as cause of AUB

A

endometrial hyperplasia with proliferation or irregular sized shaped and glands. increased gland to stroma ratio

  • complex vs simple types
  • atypical vs typical types
38
Q

dx of endometrial hyperplasia

A

sampling of endometrium with a pipel

39
Q

risk factors for endometrial hyperplasia and malignancy

A
  • age
  • obesity (BMI >30)
  • nulliparity
  • PCOS
  • diabetes
  • HNPCC (Lynch)
40
Q

tx of endometrial hyperplasia

A
  • progestins (oral or LNG-IUS)
  • hysterectomy if complex, atypica, EIN
  • endometrial cancer = refer, surgery, chemo radiation
41
Q

2 most common coagulopathies and causing AUB

A
  • Von Willebrand’s disease (platelet factor deficiency)

- thrombocytopenia (platelets dysfct)

42
Q

coagulopathy causing AUB dx

A

FHx of bleeding in adolescent at menarche

43
Q

ovulatory disorders causing AUB sx

A

always changing mix of

  • amenorrhea
  • heavy menstrual bleeding
  • metrorrhagia (between periods)
44
Q

causes of ovulatory disorders

A

causes of oligomenorrhea, amenorrhea

45
Q

tx of ovulatory disorders causing AUB

A
  • tx cause of oligo
  • COC
  • progestins (cyclic or LNG-IUS)
46
Q

endometrial dysfct as cause of AUB def

A
  • regular heaving bleeding (hypermenorrhea)
  • dx of exclusion
  • disorder of primary mechanisms in endometrial hemostasis (deficiency in local vasoconstrictors)
47
Q

endometrial dysfct as cause of AUB tx

A

same as cause of oligom, amenorrh, ovulatory dysfct

48
Q

iatrogenic causes of AUB

A

medications

  • SE of contraceptives (COC, copper IUD, LNG-IUS)
  • HRT
  • OTC meds
  • aco
  • SSRI
  • CS
  • antipsychotic
  • tamoxifen
49
Q

not yet classified causes of AUB def

A
  • chronic endometritis
  • AV malformation
  • myometrial hypertrophy
50
Q

NYC causes of AUB dx

A

endometrial bx

51
Q

infectious causes of AUB

A
  • PID

- cervicitis (chlamydia, gonorrhea)

52
Q

PID sx

A
  • fever
  • pelvic discomfort
  • adnexal tenderness
  • menorrhagia
  • metrorrhagia
53
Q

postmenopausal bleeding def

A

1 year after cessation of menses. becomes ABNORMAL

54
Q

main causes of PMB

A 
#1 vaginal atrophy
#2 polyps
-HRT
-endometrial hyperplasia
-endometrial cancer
55
Q

postmenopausal bleeding imp things in hx

A

RFs for endometrial cancer

56
Q

postmenopausal bleeding PE

A
  • endometrial bx

- PAP test

57
Q

PMB imaging

A

pelvic US, dx hysteroscopy

58
Q

tx of PMB caused by vaginal atrophy

A

topical estrogen (most effective = vaginal estrogen via a ring or pill with inserter)

Bloc I - Reproduction (57 decks)

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