Your Bleeding!

Question 1

What is Menorrhagia?

Answer 1

prolong or excessive bleeding at REGULAR intervals

Loss of 80cc per cycle

Cycle lasting more than 7 days

Question 2

What is polymenorrhea?

Answer 2

bleeding occurring at intervals of every 21 days or less

Question 3

What is metorrhagia?

Answer 3

irregular bleeding or bleeding between periods

Question 4

What is oligomenorrhea?

Answer 4

bleeding occurring LESS frequently than 35days

Question 5

What systemic diseases can cause abnormal bleeding

Answer 5

hypothyroid
hyperprolactinemia
primay pituitary disease
coagulopathy

Question 6

What iatrogenic things can cause abnormal bleeding

Answer 6

chemotherapy, medication

Question 7

Biggest thing they forget to consider which causes abnormal bleeding

Answer 7

PREGANCY

Question 8

PALM stands for what?

Answer 8

Polyp
Adenomyosis
Leiomyomata
Malignancy & hyperplasia

Question 9

What does COEIN describe?

Answer 9

nonstructural causes

Question 10

What does COEIN stand for?

Answer 10

C- coagulopathy
O- ovulatory dysfunction
E- enodmetrial
I- iatrogenic
N- not yet classified

Question 11

What is a inherited coagulopathy?

Answer 11

von Willebrandt disease

Question 12

What are acquired diseases that cause bleeding?

Answer 12

warfarin, heparin, NSAID, clopidogrel, aspirin, hormonal contraceptives, ginkgo, ginseng, motherwart

Question 13

Most common cause of abnormal uterine bleeding?

Answer 13

ovulatory AUB

Question 14

Ovulatory AUB is most common related to ?

Answer 14

ovulatory dysfunction

Question 15

What are two things are intact and normal in ovulatory AUB?

Answer 15

hypothalamic pituitary axis

steroid hormone profiles

Question 16

What are the 3 mechanisms of AUB?

Answer 16

1) Abnormal PG synthesis and receptor up regulation
2) increased local fibrinolytic activity
3) increased tpa activity

Question 17

What causes anovulatory AUB?

Answer 17

result of endocrinopathy (PCOS)

Question 18

What is the mechanism of AUB-O

Answer 18

unopposed estrogen

Question 19

What is the bleeding characteristic of AUB-O?

Answer 19

Ranges of amenorrhea to irregular heavy cycles

Question 20

What is endometrosis

Answer 20

benign condition in which endometrial glands and stroma are present outside the uterine cavity and walls

Question 21

Endometriosis triad?

Answer 21

dysmenorrhea, dyspareunia (deep), and dyschezia

Question 22

What causes endometrosis?

Answer 22

not a single theory explains all cases

Question 23

What theory most commonly is used to explain endometriosis?

Answer 23

Implantation theory (Retrograde Menstruation)

Question 24

What is the implantation theory?

Answer 24

retrograde mensuration, common in women w/ patent fallopian tubes

Question 25

The diagnosis of endometriosis is made by?

Answer 25

direct visualization w/ laparoscopy or laparotomy

Question 26

Risk factors for endometriosis?

Answer 26

cervical/vaginal atresia, early menarche, longer and heavy flow, decreased w/ low estrogen

Question 27

So does the amount of endometriosis correlate w/ the patient's symptoms?

Answer 27

NO

Question 28

T/F it is acceptable to initiate medical treatment if you suspect endometriosis?

Answer 28

YES pt will follow up in 3-6 mo to assess response if no response consider diagnostic laparoscopy

Question 29

What is the medical treatment for endometriosis?

Answer 29

NSAIDS, OCPs, IUD- Levonorgestrel, Progestin, GnRH agonist (Depolupron), Danazol

Question 30

What is a problem with GnRH agonist?

Answer 30

Chemical Menopause

Question 31

How long is the GnRH agonist given?

Answer 31

6 months (short duration)

Question 32

If the patient is satisfied with GnRH treatment what can she then do?

Answer 32

continue w/ tx for more than 6 months, provided that she is placed on "add-back" therapy

Question 33

What drugs are included in the add back therapy?

Answer 33

- Norethindrone acetate 10mg/d - Conjugated estrogen 0.3-0.625 w/ Medroxyprogesterone - Micronized Estradiol w/ Medroxyprogesterone acetaete

Question 34

What guides the surgical treatment for endometriosis?

Answer 34

desire for future fertility

Question 35

If the patient desires future fertility in endometriosis what surgical procedure should be done?

Answer 35

Laparoscopic or open surgery | destroy all endometriotic implants and remove all adhesive disease

Question 36

If patient does not desire future fertility?

Answer 36

comprehensive surgery (total abdominal hysterectomy, bilateral salpingoophorectomy)

Question 37

Who is more at risk for endometriosis?

Answer 37

White >Blacks or Asian

Question 38

How does retrograde menstruation create endometriosis?

Answer 38

fluid spills in the peritoneum and attaches

Question 39

What are women with endometriosis at risk for?

Answer 39

endometrium cancer

Question 40

How do endometrium implants look?

Answer 40

superficial powder burn lesions, can be black, brown, bluish lesions, nodules

Question 41

Contains thick dark " chocolate fluid"

Answer 41

endometrioma (viewed by sonogram)

Question 42

Minimal endometrium implants have?

Answer 42

isolated implants

Question 43

Severe endometrium implants have?

Answer 43

multiple implants, large endometriomas, adhesions

Question 44

Mild endometrium implants have?

Answer 44

scattered lesions less than 5cm in aggregate, no adhesions

Question 45

Moderate endometrium implants have?

Answer 45

multiple implants, adhesions

Question 46

What does PALM-COEIN classify abnormal bleeding by?

Answer 46

pattern and etiology

Question 47

Who is at risk for malignancy and hyperplasia in AUB?

Answer 47

nulliparity, late menopause, Tamoxifen, obesity

Question 48

What causes abnormal bleeding at birth?

Answer 48

estrogen withdrawal

Question 49

Medical therapy for AUB-O?

Answer 49

cyclic or continous provera OCP NSAID Tranexamic acid (lysteda)

Question 50

What procedures are done for AUB-O?

Answer 50

IUD (Levonorgestrel)

Question 51

Some surgical options for AUB-O?

Answer 51

Hysteroscopy D&C No interested in childbearing: endometrial ablation Hysterectomy

Question 52

What is the follow up for AUB?

Answer 52

Recheck hct after 8 wks of therapy Patience Improvement seen after 2-3 months generally

Question 53

What should be done in a emergency for AUB?

Answer 53

OCP taper IV estrogen Tranfusion Emergent D&C