vaginal bleeding Flashcards
what age is average menarche and menopause
11 and 51
what is the most common cause of premenarchal bleeding
foreign object due to self insertion
what is the most common cause of reproductive age bleeding?
pregnancy
what is the most of postmenopausal bleeding
vaginal atrophy (especially after sex)
what is important to consider in premenarche
sexual abuse
precocious puberty
what is important to consider in postmenopasusal
endometrial cancer
what is important to consider in reproductive age
think PAD (pregnancy, anatomy, abnormal uterine bleeding) Don't rule out cervical cancer but this is decreasing
How do we do a speculum exam on a minor and why
under anesthesia because its dramatic
How to shut off acute bleeding of the uterus
IV estrogen
what is an absolute indication for significant uterine bleeding
hemoglobin < 7
what is a mechanical method for hemorrhaging
intracavitary tamponade
what is the most absolute cure for hemorrhaging
total hysterectomy
what are the stages of abortion?
IUP-threatened-inevitable-incomplete-complete
IUP definition
closed os, ultrasound shows live baby, no passage of contents.
threatened abortion defined
closed os, no passage of contents, live baby.
inevitable abortion definition
no passage of contents, dead baby, open os
incomplete abortion definitino
passage of contents (some), retained parts, open os baby always dead.
complete abortion
passage of contents is complete, closed os, no baby on ultrasound
missed abortion
no passage of contents, dead baby, closed os. mom missed the death of baby and usually doesnt know that this happened.
what to do with missed abortion
misprostol (1st trimester), induce delivery pitocin, d and c.
what do we give Rh negative mothers
RhoGAM
what are fibroids
leiomyoma are benign growths of the myometrium and respond to estrogen. They DO NOT cause cancer. highly vascular
how to fibroids present
anemia, pain, infertility, visceral obstruction.
how to diagnose firboids
transvaginal ultrasound, but the best is MRI. MRI is never gotten.
treatment of fibroids
medicine: OCP/IUD. NSAIDs for pain.
surgery: fertility is the question. if she wants kids then do myomectomy which is usually not effective long term. Hysterectomy is usually best.
can give leuprolide to shrink d
what is leuprolide
a GnRH analog that decreases testosterone and estradiol production.
when is AUB
reproductive age woman only
first line therapies for AUB
1) NSAIDs (can actually reduce bleeding because of their negative impact on prostaglandin
2) OCP/IUD
3) ablation or hysterectomy
why is PCOS important for AUB
because this is classic anovulation which causes a predominantly estrogen++ system and also makes testosterone. Thus she becomes him.
where does testosterone in PCOS come from
atretic follicles.
how does PCOS present/diagnose
fat, hairy woman. metabolic syndrome. dyslipidemia, diabetes, infertility, hypertension. menometrorrhagia (no system control)
need hyperandrogenism (DHEAs, testosterone, LH/FSH ratio > 3:1
imaging for follicles
what is the biochemical test and result that suggests PCOS
LH/FSH ratio >3:1
what is the treatment for PCOS
weight loss and exercise can produce results, but never by themselves. METFORMIN is the treatment OCPs and IUDs Clomiphine for helping with pregnancy. spironoleptone.
why metformin for PCOS
pushes PCOS into ovulation
what are the causes of AUB
PALM-COEIN: polyp, adenomyosis, leiomyomas, malignancy, coagulopathy, ovulapathy, endometrial issues, iatrogenic (IUD), not yet specified.
what is a fibroid?
benign growth within the endometrium. nodular, asymmetric
what are the different types of fibroids?
subsereosal, submucosal, transmural, abdominal, peduculated
what is adenomyosis
endometrial growth, proliferatio of glandular tissue. SYMMETRIC. smooth and boggy
Polyps are what?
peduculated mass in the uterus
do fibroids cause cancer?
NO.
are fibroids estrogen responsive>?
Yes. they may change with cycles. proliferate under cycles
what is the patient experience of fibroids
asymptomatic lump, anemia/bleeding (highly vascular), painful, may cause infertility.
what is a complication of large fibroids
visceral obstruction
what is the diagnostic step for fibroids?
works: transvaginal ultrasound…MRI is best
best test is Biopsy.
treatment of fibroids
meds: oral contraceptives (or IUD). NSAIDs for pain.
surgery: does the patient want kids? wants kids: myomectomy (scooping out fibroids). hysterectomy –satisfaction rate is HIGH.
leuprolide (gNRH) to shrink the fibroids.
what does ovulation do?
switches axis to progesterone to stop proliferation of the endometrium
what does estrogen do?
builds the endometrium. if there is no ovulation, then the endometrium will continue to build until it becomes avascular and eventually sheds–AUB
when is AUB normal?
during menarche and menses
treatment for AUB
medical: OCP (IUD also) –take over the cycle.
NSAIDs can reduce bleeding.
have a predominant prostaglandin effect in the uterus, thus they slow down bleeding
surgery: ablation and hysterectomy.
