U4: abnormal uterine bleeding Flashcards
1
Q
evaluation of AUB depends on _____ and ______
A
age & risk factors
2
Q
normal menstrual bleeding lasts an average of _____
A
5 days (range 2-7)
3
Q
menorrhagia is defined as blood loss over _____ml per cycle
A
80
4
Q
menorrhagia frequently causes _______
A
anemia
5
Q
metrorrhagia is?
A
bleeding between periods
6
Q
polymenorrhea is?
A
bleeding that occurs more often than every 21d
7
Q
oligomenorrhea is?
A
bleeding that occurs less frequently than every 35d
8
Q
AUB bleeding pattern is described as
A
- heavy, light
* menstrual, intermenstrual
9
Q
AUB bleeding is classified by _____ and _____
A
bleeding pattern
etiology
10
Q
what is the acronym for AUB etiologies?
A
PALM-COEIN
11
Q
what does the PALM in PALM COEIN stand for?
A
P = polyp A = adenomyosis L = leiomyoma M = malignancy/hyperplasia
12
Q
what does the COEIN in PALM COEIN stand for?
A
C = coagulopathy O = ovulatory dysfunction E = endometrial I = iatrogenic N = not yet classified
13
Q
AUB in adolescents is most often due to persistent _____ due to the ________ of the _______. is this normal or abnormal?
A
- anovulation
- immaturity
- HPO (hypothalamic-pituitary-ovarian) axis
- its normal
14
Q
what is the most common cause of AUB in adolescents with regular menses?
A
ovulatory dysfunction AUB
AUB-O
15
Q
diagnosis of AUB depends on (1/5): ________ and _______ of flow
A
duration and amount (# of pads/tampons used)
16
Q
diagnosis of AUB depends on (2/5): associated ______
A
pain
17
Q
diagnosis of AUB depends on (3/5): relationship to ______
A
LMP
18
Q
diagnosis of AUB depends on (4/5): presence of _______
A
blood clots
19
Q
diagnosis of AUB depends on (5/5): degree of _______ caused by bleeding
A
inconvenience
20
Q
diagnosis of AUB will include assessment of hx of pertinent _____ such as
A
illnesses such as recent systemic infection, other significant physical issues
21
Q
diagnosis of AUB will include assessing hx of _______ stressors such as _______
A
emotional stressors such as thyroid disease, weight change
22
Q
diagnosis of AUB will include assessing hx of which three rx medications:
A
- warfarin
- heparin
- exogenous hormone
23
Q
diagnosis of AUB will include assessing for hx of which 3 herbal remedies?
A
- gingko
- motherwort
- ginseng
24
Q
diagnosis of AUB will include assessing for pt and family hx of ______
A
coagulation disorders
25
physical exam for diagnosis of AUB will include: evaluate for excessive ______, signs of ____,_____,_____ or ______ disorder
* excessive weight gain
* signs of PCOS, thyroid disease, insulin resistance
* bleeding disorder
26
pelvic exam for AUB diagnosis will include assessment and rule out of other causes such as (6) (PILAAU)
* pregnancy
* infection
* lesions of vulva/vag/cervix
* adnexal masses
* adenomyosis
* uterine myomas
27
lab studies useful for diagnosing AUB include?
* pregnancy test
* thyroid test
* CBC (for anemia)
28
progestins _____ and _____ endometrial growth
*limit and stabilize
29
progestins limit and stabilize ______ growth
endometrial
30
med for AUB-O irregular or light bleeding
*medroxy-progesterone acetate 10mg/day
OR
*norethindrone acetate 5mg/day
31
med for AUB-O menorrhagia
NSAIDS
* naproxen
* mafenamic acid
32
meds for AUB-O with heavy bleeding
taper COC's w 30-35mcg of estrogen estradiol to control the bleeding
33
meds for AUB with intractable heavy bleeding
* will be managed w OB
* GnRH agonist (depot leurolide) IM Qmonth for upt o 6m to suppress ovaries
* requires 2-4w to down-regulate pituitary & stop bleeding
* AKA NOT an acute treatment
34
meds for AUB-O heavy bleeding requiring hospitalization
*medroxyprogesterone acetate 10mg PO/day x 10d
35
tx for idiopathic AUB-O unresponsive to medical therapy
* uterine ablation
* levonorgestrel IUD
* hysterectomy (last resort)
36
when to refer AUB-O
* bleeding not controlled with 1st line therapy
| * pt needs surgery
37
when to admit AUB-O
* uncontrolled bleeding w 1st line therapy
| * hemodynamically unstable
38
what is anovulatory AUB/DUB?
* irregular cycle
* short cycle
* scanty flow or period of ammenorrhea
39
alteration in the _______ is the cause of anovulatory AUB
hypothalamic-pituitary axis
40
in anovulatory AUB unopposed production of _______ stimulates overgrowth of the _____ and eventually causes _______ and ________
* estradiol
* endometrium
* necrosis and irregular bleeding
41
95% of AUB in adolescents is due to ______
anovulation
42
menstrual history for all pts includes 7 aspects:
1. Age of menarche
2. length of cycle
3. duration of bleeding
4. flow: light, medium, heavy
5. products used
6. first day LMP
7. dysmenorrhea
43
menstrual history for pts reporting heavy menstrual bleeding includes 6 questions.
1. soaking thru a pad/tampon in 1h for 2-3h in a row?
2. blood clots >1in?
3. doubled up? (2 pads or 2 tampons)
4. flooding or gushing sensation?
5. frequent leaking thru protection?
6. hx of anemia?
44
approx 82% of adolescent females experience _____ for up to _____y after menarch
* anovulation
| * 2
45
3 things to assess for HD stability in office
* pallor
* tachycardia
* murmur
46
townsend meds for AUB if not bleeding (2)
*cyclic OCP
--medroxyprogesterone acetate (depo provera)
OR
*noethindrone
47
townsend meds for AUB with bleeding
*monophasic OCP 30-50ug ehinyl estradiol/0.3mg norgestrel
48
townsend meds for AUB when estrogen is contraindicated
*norethindrone acetate 5-10mg
49
AUB + hbg less than ______ gets referred to ____
7, ED
50
AUB + ________ BP gets referred to ______
orthostatic, ED
51
AUB with heavy bleeding less than ___ months and normal _____ is considered?
* less than 3months
* HGB
* MILD
52
MODERATE AUB is described as ______ and ______ menses with mild ______
* heavy
* frequent (1-3w)
* anemia
53
SEVERE AUB is described as a _______ and ______ flow with HGB less than ______
* prolonged
* heavy
* less than 9
54
SE of estrogen to keep in mind when prescribing
* nausea
| * consider rx'ing antiemetic
55
treatment for MILD AUB
* observation
* keep menstrual calendar
* NSAIDS
56
treatment for MODERATE AUB
* MEDS
* not currently bleeding: cyclic OCP (medroxyprogesterone acetate OR norethindrone acetate)
* bleeding: taper monophasic OCPs
* norethindrone acetate 5-10mg daily for estrogen contraindication
57
treatment for SEVERE AUB if hgb 8-10
* taper OCPs, use every 4h until bleeding slows
* iron supplementation
* antiemetics (phenergan)
58
medication to treat heavy menses but not affect fertility
tranexamic acid (antifibrinolytic)
59
tranexamic acid should be used with caution in women with a personal hx of
thromboembolism
60
maintenance of progesterone exposures limits __________ and prevents _________
* limits endometrial inflammation
| * prevents menstruation
61
hormonal treatment for UAB will limit or remove _______
fertility
62
component of menstrual hx: age of ______
*menarche
63
component of menstrual hx: cycle _____
*length
64
component of menstrual hx: _______ of bleeding
*duration
65
component of menstrual hx: _______ of flow
*perception of flow (light, medium, heavy)
66
component of menstrual hx: ________ use
*menstrual product
67
component of menstrual hx: ________ of LMP
*first day
68
menstrual hx comp for HMB: soaking thru pads/tampons in ______ for ______ in a row?
1h for 2-3h in a row
69
menstrual hx component for HMB: _____ over _____ in in diameter?
* blood clots > 1inch
| * approx size of quarter
70
menstrual hx component for HMB: using _______ protection?
*double
71
menstrual hx component for HMB: __________ sensation?
*flooding or gushing
72
menstrual hx component for HMB: frequent _______ or ________ thru protection?
* accidents
| * leaking thru protection
73
menstrual hx component for HMB: ever dx'd w ______?
*anemia
74
women suffering from HMG have been shown to have an overactivation of the _______ system during the menstrual phase of cycle. which causes ______ blood loss during ______ shedding
* fibrinolytic
* increased
* endometrial
75
injectable progesterone pro: offers women an alternative to _____ or ______ and is given every _________
* pills or
* IUD
* given every 12w
76
injectable progesterone is EXCELLENT for women experiencing frequent or irregular _______ bleeding
*heavy
77
injectable progesterone CAUTION
decreases BMD with long term use. limit to 2y
78
GnRH agonists delivery systems (3)
* IM
* subQ
* intranasal
79
GnRH agonists MOA
*medical menopause
80
GnRH agonists use:
*treatment of uterine fibroids (leiomyoma)
81
GnRH agonists SE
* flushing
* vaginal dryness
* HA
* decreased libido
82
most commonly used oral progesterone
*norethisterone
83
norethisterone MOA
*reduce blod loss by >80%
84
norethisterone is usually prescribed for _______ measures such as
* short
| * vacations/events
85
Levonorgestrel releasing intrauterine system (LNG-IUD) MOA
*decreases menstrual loss by up to 96% after 1y of use. good for 5y
86
LNG-IUD PRO
* increased compliance
| * reduces dysmenorrhea
87
LNG-IUD complication: unscheduled ______
*bleeding
88
LNG-IUD complication:
infection
* prevent by not using tampons for 3w.
* seek medical attn for vaginal dc
89
LNG IUD complication
* expulsion
* risk highest in nulliparous women
* have exam or self check 6w after insertion
90
LNG IUD complication:
* perforation
| * refere for US & ABD xray
91
SPRM for HMB:
ulipristal acetate (UPA)
92
use of UPA is restricted to ____months prior to surgical removal of _____
* 3m
| * fibroids
93
UPA is effective in treating HMB AW uterine fibroids ___- to _____ cm in size
*3-10cm
94
control of HMB was achieved quicker in the UPA group versus the _____ group
*GnRH agonist
95
UPA SE were limited to two minor compliants:
* HA
| * breast complaints
96
there have been no studies on UPA for mgmt of ___
*non-fibroid associated bleeding
97
COC MOA
additional benefit of regulation of bleeding
98
COC PRO: excellent for women experiencing frequent or irregular _______
*heavy bleeding
99
COC contra's
*BMI >35
*smoker >35y
*HTN
*vascular disease
*migraine w aura
*current/recent BrCA
*person or fam hx VTE
*
