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CMN572 > U4: abnormal uterine bleeding > Flashcards

U4: abnormal uterine bleeding Flashcards

1
Q

evaluation of AUB depends on _____ and ______

A

age & risk factors

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2
Q

normal menstrual bleeding lasts an average of _____

A

5 days (range 2-7)

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3
Q

menorrhagia is defined as blood loss over _____ml per cycle

A

80

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4
Q

menorrhagia frequently causes _______

A

anemia

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5
Q

metrorrhagia is?

A

bleeding between periods

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6
Q

polymenorrhea is?

A

bleeding that occurs more often than every 21d

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7
Q

oligomenorrhea is?

A

bleeding that occurs less frequently than every 35d

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8
Q

AUB bleeding pattern is described as

A
  • heavy, light

* menstrual, intermenstrual

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9
Q

AUB bleeding is classified by _____ and _____

A

bleeding pattern

etiology

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10
Q

what is the acronym for AUB etiologies?

A

PALM-COEIN

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11
Q

what does the PALM in PALM COEIN stand for?

A 
P = polyp
A = adenomyosis
L = leiomyoma
M = malignancy/hyperplasia
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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
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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
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14
Q

what is the most common cause of AUB in adolescents with regular menses?

A

ovulatory dysfunction AUB

AUB-O

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15
Q

diagnosis of AUB depends on (1/5): ________ and _______ of flow

A

duration and amount (# of pads/tampons used)

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16
Q

diagnosis of AUB depends on (2/5): associated ______

A

pain

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17
Q

diagnosis of AUB depends on (3/5): relationship to ______

A

LMP

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18
Q

diagnosis of AUB depends on (4/5): presence of _______

A

blood clots

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19
Q

diagnosis of AUB depends on (5/5): degree of _______ caused by bleeding

A

inconvenience

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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

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21
Q

diagnosis of AUB will include assessing hx of _______ stressors such as _______

A

emotional stressors such as thyroid disease, weight change

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22
Q

diagnosis of AUB will include assessing hx of which three rx medications:

A
  • warfarin
  • heparin
  • exogenous hormone
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23
Q

diagnosis of AUB will include assessing for hx of which 3 herbal remedies?

A
  • gingko
  • motherwort
  • ginseng
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24
Q

diagnosis of AUB will include assessing for pt and family hx of ______

A

coagulation disorders

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25
Q

physical exam for diagnosis of AUB will include: evaluate for excessive ______, signs of ____,_____,_____ or ______ disorder

A
  • excessive weight gain
  • signs of PCOS, thyroid disease, insulin resistance
  • bleeding disorder
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26
Q

pelvic exam for AUB diagnosis will include assessment and rule out of other causes such as (6) (PILAAU)

A
  • pregnancy
  • infection
  • lesions of vulva/vag/cervix
  • adnexal masses
  • adenomyosis
  • uterine myomas
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27
Q

lab studies useful for diagnosing AUB include?

A
  • pregnancy test
  • thyroid test
  • CBC (for anemia)
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28
Q

progestins _____ and _____ endometrial growth

A

*limit and stabilize

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29
Q

progestins limit and stabilize ______ growth

A

endometrial

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30
Q

med for AUB-O irregular or light bleeding

A

*medroxy-progesterone acetate 10mg/day
OR
*norethindrone acetate 5mg/day

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31
Q

med for AUB-O menorrhagia

A

NSAIDS

  • naproxen
  • mafenamic acid
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32
Q

meds for AUB-O with heavy bleeding

A

taper COC’s w 30-35mcg of estrogen estradiol to control the bleeding

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33
Q

meds for AUB with intractable heavy bleeding

A
  • 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
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34
Q

meds for AUB-O heavy bleeding requiring hospitalization

A

*medroxyprogesterone acetate 10mg PO/day x 10d

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35
Q

tx for idiopathic AUB-O unresponsive to medical therapy

A
  • uterine ablation
  • levonorgestrel IUD
  • hysterectomy (last resort)
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36
Q

when to refer AUB-O

A
  • bleeding not controlled with 1st line therapy

* pt needs surgery

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37
Q

when to admit AUB-O

A
  • uncontrolled bleeding w 1st line therapy

* hemodynamically unstable

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38
Q

what is anovulatory AUB/DUB?

A
  • irregular cycle
  • short cycle
  • scanty flow or period of ammenorrhea
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39
Q

alteration in the _______ is the cause of anovulatory AUB

A

hypothalamic-pituitary axis

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40
Q

in anovulatory AUB unopposed production of _______ stimulates overgrowth of the _____ and eventually causes _______ and ________

A
  • estradiol
  • endometrium
  • necrosis and irregular bleeding
41
Q

95% of AUB in adolescents is due to ______

A

anovulation

42
Q

menstrual history for all pts includes 7 aspects:

A
  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
Q

menstrual history for pts reporting heavy menstrual bleeding includes 6 questions.

A
  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
Q

approx 82% of adolescent females experience _____ for up to _____y after menarch

A
  • anovulation

* 2

45
Q

3 things to assess for HD stability in office

A
  • pallor
  • tachycardia
  • murmur
46
Q

townsend meds for AUB if not bleeding (2)

A

*cyclic OCP
–medroxyprogesterone acetate (depo provera)
OR
*noethindrone

47
Q

townsend meds for AUB with bleeding

A

*monophasic OCP 30-50ug ehinyl estradiol/0.3mg norgestrel

48
Q

townsend meds for AUB when estrogen is contraindicated

A

*norethindrone acetate 5-10mg

49
Q

AUB + hbg less than ______ gets referred to ____

A

7, ED

50
Q

AUB + ________ BP gets referred to ______

A

orthostatic, ED

51
Q

AUB with heavy bleeding less than ___ months and normal _____ is considered?

A
  • less than 3months
  • HGB
  • MILD
52
Q

MODERATE AUB is described as ______ and ______ menses with mild ______

A
  • heavy
  • frequent (1-3w)
  • anemia
53
Q

SEVERE AUB is described as a _______ and ______ flow with HGB less than ______

A
  • prolonged
  • heavy
  • less than 9
54
Q

SE of estrogen to keep in mind when prescribing

A
  • nausea

* consider rx’ing antiemetic

55
Q

treatment for MILD AUB

A
  • observation
  • keep menstrual calendar
  • NSAIDS
56
Q

treatment for MODERATE AUB

A
  • MEDS
  • not currently bleeding: cyclic OCP (medroxyprogesterone acetate OR norethindrone acetate)
  • bleeding: taper monophasic OCPs
  • norethindrone acetate 5-10mg daily for estrogen contraindication
57
Q

treatment for SEVERE AUB if hgb 8-10

A
  • taper OCPs, use every 4h until bleeding slows
  • iron supplementation
  • antiemetics (phenergan)
58
Q

medication to treat heavy menses but not affect fertility

A

tranexamic acid (antifibrinolytic)

59
Q

tranexamic acid should be used with caution in women with a personal hx of

A

thromboembolism

60
Q

maintenance of progesterone exposures limits __________ and prevents _________

A
  • limits endometrial inflammation

* prevents menstruation

61
Q

hormonal treatment for UAB will limit or remove _______

A

fertility

62
Q

component of menstrual hx: age of ______

A

*menarche

63
Q

component of menstrual hx: cycle _____

A

*length

64
Q

component of menstrual hx: _______ of bleeding

A

*duration

65
Q

component of menstrual hx: _______ of flow

A

*perception of flow (light, medium, heavy)

66
Q

component of menstrual hx: ________ use

A

*menstrual product

67
Q

component of menstrual hx: ________ of LMP

A

*first day

68
Q

menstrual hx comp for HMB: soaking thru pads/tampons in ______ for ______ in a row?

A

1h for 2-3h in a row

69
Q

menstrual hx component for HMB: _____ over _____ in in diameter?

A
  • blood clots > 1inch

* approx size of quarter

70
Q

menstrual hx component for HMB: using _______ protection?

A

*double

71
Q

menstrual hx component for HMB: __________ sensation?

A

*flooding or gushing

72
Q

menstrual hx component for HMB: frequent _______ or ________ thru protection?

A
  • accidents

* leaking thru protection

73
Q

menstrual hx component for HMB: ever dx’d w ______?

A

*anemia

74
Q

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

A
  • fibrinolytic
  • increased
  • endometrial
75
Q

injectable progesterone pro: offers women an alternative to _____ or ______ and is given every _________

A
  • pills or
  • IUD
  • given every 12w
76
Q

injectable progesterone is EXCELLENT for women experiencing frequent or irregular _______ bleeding

A

*heavy

77
Q

injectable progesterone CAUTION

A

decreases BMD with long term use. limit to 2y

78
Q

GnRH agonists delivery systems (3)

A
  • IM
  • subQ
  • intranasal
79
Q

GnRH agonists MOA

A

*medical menopause

80
Q

GnRH agonists use:

A

*treatment of uterine fibroids (leiomyoma)

81
Q

GnRH agonists SE

A
  • flushing
  • vaginal dryness
  • HA
  • decreased libido
82
Q

most commonly used oral progesterone

A

*norethisterone

83
Q

norethisterone MOA

A

*reduce blod loss by >80%

84
Q

norethisterone is usually prescribed for _______ measures such as

A
  • short

* vacations/events

85
Q

Levonorgestrel releasing intrauterine system (LNG-IUD) MOA

A

*decreases menstrual loss by up to 96% after 1y of use. good for 5y

86
Q

LNG-IUD PRO

A
  • increased compliance

* reduces dysmenorrhea

87
Q

LNG-IUD complication: unscheduled ______

A

*bleeding

88
Q

LNG-IUD complication:

A

infection

  • prevent by not using tampons for 3w.
  • seek medical attn for vaginal dc
89
Q

LNG IUD complication

A
  • expulsion
  • risk highest in nulliparous women
  • have exam or self check 6w after insertion
90
Q

LNG IUD complication:

A
  • perforation

* refere for US & ABD xray

91
Q

SPRM for HMB:

A

ulipristal acetate (UPA)

92
Q

use of UPA is restricted to ____months prior to surgical removal of _____

A
  • 3m

* fibroids

93
Q

UPA is effective in treating HMB AW uterine fibroids ___- to _____ cm in size

A

*3-10cm

94
Q

control of HMB was achieved quicker in the UPA group versus the _____ group

A

*GnRH agonist

95
Q

UPA SE were limited to two minor compliants:

A
  • HA

* breast complaints

96
Q

there have been no studies on UPA for mgmt of ___

A

*non-fibroid associated bleeding

97
Q

COC MOA

A

additional benefit of regulation of bleeding

98
Q

COC PRO: excellent for women experiencing frequent or irregular _______

A

*heavy bleeding

99
Q

COC contra’s

A

*BMI >35
*smoker >35y
*HTN
*vascular disease
*migraine w aura
*current/recent BrCA
*person or fam hx VTE
*

CMN572 (13 decks)

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