Sept5 A1-Abnormal_uterine_bleeding Flashcards
(58 cards)
1
Q
menorrhagia def
A
prolonged duration of cycle and excessive flow (>7 days, >80 ml of blood)
2
Q
metrorrhagia def
A
irregular cycles or bleeding between periods
3
Q
menometrorrhagia def
A
frequent menstrual bleeding that is excessive and irregular in amount and duration (mix of metro and menorrhagia)
4
Q
hypermenorrhea def
A
regular cycles, normal duration, excessive flow**
5
Q
polymenorrhea def
A
frequent** menstrual bleeding (cycle less than 21 days)
6
Q
oligomenorrhea def
A
infrequent cycles (<8 per year)
7
Q
dysmenorrhea def
A
painful period
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)
9
Q
FIGO classif of causes of AUB
A
- PALM
- COEIN
- pregnancy
- infection
10
Q
PALM part of FIGO classif of AUB causes
A
are structural causes
- polyp
- adenomyosis
- leiomyoma
- malignancy and hyperplasia
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
12
Q
how pregnancy can cause AUB
A
- implantation
- abortion
- ectopic pregnancy
- gestational trophoblastic disease
- postpartum infection
13
Q
how infection can cause AUB
A
- STD
- TB
- chronic endometritis
- postabortal or postpartum infection
14
Q
imp hx steps in AUB
A
- anemia sx
- cervical cancer screen
- dysmenorrhea
- pelvic pain, pressure
15
Q
imp PE steps in AUB
A
- abdo exam to palpate fibroids
- bimanual exam to feel pelvic masses, fibroids, etc.
- thyroid exam
16
Q
imp lab studies in AUB
A
- CBC
- bHCG (pregnancy)
- TSH (hypo or hyperT)
- PT, PTT and bleeding
- PCOS and CAH investigations
17
Q
imp imaging study in AUB
A
ultrasound
- PCOS
- fibroids, adenomyosis
- endometrial stripes (to eval thickness)
18
Q
endometrial polyps sx
A
- intermenstrual bleeding
- irregular bleeding
- menorrhagia
19
Q
cervical polyps sx
A
- intermenstrual spotting
- postcoital spotting
20
Q
main way to dx endometrial polyp
A
pelvic US
21
Q
when to treat endometrial polyps
A
- sx
- risk factors for malignant transformation (including tamoxifen use)
- tx is surgery*
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
23
Q
adenomyosis def
A
ectopic rests of endometrium in the myometrium
24
Q
sx of adenomyosis
A
- menorrhagia
- dysmenorrhea
- large uterus, no fibroids
25
dx of adenomyosis
- clincally
| - US
26
when to tx adenomyosis
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
LNG-IUS is what
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
GnRH agonist effect
stops period and puts you in medical menopause. acts on HPO axis
29
leiomyoma (fibroids) def
- benign SM neoplasm from myometrium
| - each one derives from single progenitor myocyte
30
most common pelvic tumor in women
fibroids (leiomyoma)
31
leiomyoma dx
- PE
| - US or MRI
32
diff possible locations of fibroids
- pedunculated serosal or submucous
- serosal
- submucous
- intramual
- intraligamentary
- cervical
33
sx of fibroids (leiomyomas)
- majority asx
- dysmenorrhea, menorrhagia
- pelvic pain and pressure + assoc bulk symptoms
- infertility bc of obstruction
34
when to tx fibroids
when sx
35
tx options for fibroids (leiomyomas) depending on sx
- 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
what's ulipristal
lactate progesterone R modulator. acts on prog Rs of fibroids to stop the bleeding.
-only prob = get unopposed estrogen effect in endo = thickening
37
PALM: malignancy and hyperplasia def as cause of AUB
endometrial hyperplasia with proliferation or irregular sized shaped and glands. increased gland to stroma ratio
- complex vs simple types
- atypical vs typical types
38
dx of endometrial hyperplasia
sampling of endometrium with a pipel
39
risk factors for endometrial hyperplasia and malignancy
- age
- obesity (BMI >30)
- nulliparity
- PCOS
- diabetes
- HNPCC (Lynch)
40
tx of endometrial hyperplasia
- progestins (oral or LNG-IUS)
- hysterectomy if complex, atypica, EIN
- endometrial cancer = refer, surgery, chemo radiation
41
2 most common coagulopathies and causing AUB
- Von Willebrand's disease (platelet factor deficiency)
| - thrombocytopenia (platelets dysfct)
42
coagulopathy causing AUB dx
FHx of bleeding in adolescent at menarche
43
ovulatory disorders causing AUB sx
always changing mix of
- amenorrhea
- heavy menstrual bleeding
- metrorrhagia (between periods)
44
causes of ovulatory disorders
causes of oligomenorrhea, amenorrhea
45
tx of ovulatory disorders causing AUB
- tx cause of oligo
- COC
- progestins (cyclic or LNG-IUS)
46
endometrial dysfct as cause of AUB def
- regular heaving bleeding (hypermenorrhea)
- dx of exclusion
- disorder of primary mechanisms in endometrial hemostasis (deficiency in local vasoconstrictors)
47
endometrial dysfct as cause of AUB tx
same as cause of oligom, amenorrh, ovulatory dysfct
48
iatrogenic causes of AUB
medications
- SE of contraceptives (COC, copper IUD, LNG-IUS)
- HRT
- OTC meds
- aco
- SSRI
- CS
- antipsychotic
- tamoxifen
49
not yet classified causes of AUB def
- chronic endometritis
- AV malformation
- myometrial hypertrophy
50
NYC causes of AUB dx
endometrial bx
51
infectious causes of AUB
- PID
| - cervicitis (chlamydia, gonorrhea)
52
PID sx
- fever
- pelvic discomfort
- adnexal tenderness
- menorrhagia
- metrorrhagia
53
postmenopausal bleeding def
1 year after cessation of menses. becomes ABNORMAL
54
main causes of PMB
```
#1 vaginal atrophy
#2 polyps
-HRT
-endometrial hyperplasia
-endometrial cancer
```
55
postmenopausal bleeding imp things in hx
RFs for endometrial cancer
56
postmenopausal bleeding PE
- endometrial bx
| - PAP test
57
PMB imaging
pelvic US, dx hysteroscopy
58
tx of PMB caused by vaginal atrophy
topical estrogen (most effective = vaginal estrogen via a ring or pill with inserter)
