Sept5 A1-Abnormal_uterine_bleeding Flashcards
menorrhagia def
prolonged duration of cycle and excessive flow (>7 days, >80 ml of blood)
metrorrhagia def
irregular cycles or bleeding between periods
menometrorrhagia def
frequent menstrual bleeding that is excessive and irregular in amount and duration (mix of metro and menorrhagia)
hypermenorrhea def
regular cycles, normal duration, excessive flow**
polymenorrhea def
frequent** menstrual bleeding (cycle less than 21 days)
oligomenorrhea def
infrequent cycles (<8 per year)
dysmenorrhea def
painful period
definition of abnormal uterine bleeding
heavy menstrual bleeding or intermenstrual bleeding. so includes
- menorrhagia (abnormal duration and amount)
- metrorrhagia (irregular)
- menometrorrhagia (irregular + abnormal duration and amount)
- hypermenorrhea (abnormal amount)
FIGO classif of causes of AUB
- PALM
- COEIN
- pregnancy
- infection
PALM part of FIGO classif of AUB causes
are structural causes
- polyp
- adenomyosis
- leiomyoma
- malignancy and hyperplasia
COEIN part of FIGO classif of AUB causes
non structural causes
- coagulopathy
- ovulatory dysfunction
- endometrial (prob of clotting (hemostasis) locally)
- iatrogenic
- not yet classified
how pregnancy can cause AUB
- implantation
- abortion
- ectopic pregnancy
- gestational trophoblastic disease
- postpartum infection
how infection can cause AUB
- STD
- TB
- chronic endometritis
- postabortal or postpartum infection
imp hx steps in AUB
- anemia sx
- cervical cancer screen
- dysmenorrhea
- pelvic pain, pressure
imp PE steps in AUB
- abdo exam to palpate fibroids
- bimanual exam to feel pelvic masses, fibroids, etc.
- thyroid exam
imp lab studies in AUB
- CBC
- bHCG (pregnancy)
- TSH (hypo or hyperT)
- PT, PTT and bleeding
- PCOS and CAH investigations
imp imaging study in AUB
ultrasound
- PCOS
- fibroids, adenomyosis
- endometrial stripes (to eval thickness)
endometrial polyps sx
- intermenstrual bleeding
- irregular bleeding
- menorrhagia
cervical polyps sx
- intermenstrual spotting
- postcoital spotting
main way to dx endometrial polyp
pelvic US
when to treat endometrial polyps
- sx
- risk factors for malignant transformation (including tamoxifen use)
- tx is surgery*
tamoxifen is what
- breast cancer med
- selective estrogen R modulators
- negative effect on estrogen R in breast but positive effect o ERs in uterus
adenomyosis def
ectopic rests of endometrium in the myometrium
sx of adenomyosis
- menorrhagia
- dysmenorrhea
- large uterus, no fibroids
dx of adenomyosis
- clincally
- US
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
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
GnRH agonist effect
stops period and puts you in medical menopause. acts on HPO axis
leiomyoma (fibroids) def
- benign SM neoplasm from myometrium
- each one derives from single progenitor myocyte
most common pelvic tumor in women
fibroids (leiomyoma)
leiomyoma dx
- PE
- US or MRI
diff possible locations of fibroids
- pedunculated serosal or submucous
- serosal
- submucous
- intramual
- intraligamentary
- cervical
sx of fibroids (leiomyomas)
- majority asx
- dysmenorrhea, menorrhagia
- pelvic pain and pressure + assoc bulk symptoms
- infertility bc of obstruction
when to tx fibroids
when sx
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
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
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
dx of endometrial hyperplasia
sampling of endometrium with a pipel
risk factors for endometrial hyperplasia and malignancy
- age
- obesity (BMI >30)
- nulliparity
- PCOS
- diabetes
- HNPCC (Lynch)
tx of endometrial hyperplasia
- progestins (oral or LNG-IUS)
- hysterectomy if complex, atypica, EIN
- endometrial cancer = refer, surgery, chemo radiation
2 most common coagulopathies and causing AUB
- Von Willebrand’s disease (platelet factor deficiency)
- thrombocytopenia (platelets dysfct)
coagulopathy causing AUB dx
FHx of bleeding in adolescent at menarche
ovulatory disorders causing AUB sx
always changing mix of
- amenorrhea
- heavy menstrual bleeding
- metrorrhagia (between periods)
causes of ovulatory disorders
causes of oligomenorrhea, amenorrhea
tx of ovulatory disorders causing AUB
- tx cause of oligo
- COC
- progestins (cyclic or LNG-IUS)
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)
endometrial dysfct as cause of AUB tx
same as cause of oligom, amenorrh, ovulatory dysfct
iatrogenic causes of AUB
medications
- SE of contraceptives (COC, copper IUD, LNG-IUS)
- HRT
- OTC meds
- aco
- SSRI
- CS
- antipsychotic
- tamoxifen
not yet classified causes of AUB def
- chronic endometritis
- AV malformation
- myometrial hypertrophy
NYC causes of AUB dx
endometrial bx
infectious causes of AUB
- PID
- cervicitis (chlamydia, gonorrhea)
PID sx
- fever
- pelvic discomfort
- adnexal tenderness
- menorrhagia
- metrorrhagia
postmenopausal bleeding def
1 year after cessation of menses. becomes ABNORMAL
main causes of PMB
#1 vaginal atrophy #2 polyps -HRT -endometrial hyperplasia -endometrial cancer
postmenopausal bleeding imp things in hx
RFs for endometrial cancer
postmenopausal bleeding PE
- endometrial bx
- PAP test
PMB imaging
pelvic US, dx hysteroscopy
tx of PMB caused by vaginal atrophy
topical estrogen (most effective = vaginal estrogen via a ring or pill with inserter)
