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Women's Health > Your Bleeding! > Flashcards

Your Bleeding! Flashcards

1
Q

What is Menorrhagia?

A

prolong or excessive bleeding at REGULAR intervals

Loss of 80cc per cycle

Cycle lasting more than 7 days

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2
Q

What is polymenorrhea?

A

bleeding occurring at intervals of every 21 days or less

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3
Q

What is metorrhagia?

A

irregular bleeding or bleeding between periods

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4
Q

What is oligomenorrhea?

A

bleeding occurring LESS frequently than 35days

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5
Q

What systemic diseases can cause abnormal bleeding

A

hypothyroid
hyperprolactinemia
primay pituitary disease
coagulopathy

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6
Q

What iatrogenic things can cause abnormal bleeding

A

chemotherapy, medication

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7
Q

Biggest thing they forget to consider which causes abnormal bleeding

A

PREGANCY

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8
Q

PALM stands for what?

A

Polyp
Adenomyosis
Leiomyomata
Malignancy & hyperplasia

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9
Q

What does COEIN describe?

A

nonstructural causes

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10
Q

What does COEIN stand for?

A 
C- coagulopathy
O- ovulatory dysfunction
E- enodmetrial
I- iatrogenic
N- not yet classified
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11
Q

What is a inherited coagulopathy?

A

von Willebrandt disease

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12
Q

What are acquired diseases that cause bleeding?

A

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

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13
Q

Most common cause of abnormal uterine bleeding?

A

ovulatory AUB

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14
Q

Ovulatory AUB is most common related to ?

A

ovulatory dysfunction

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15
Q

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

A

hypothalamic pituitary axis

steroid hormone profiles

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16
Q

What are the 3 mechanisms of AUB?

A

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

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17
Q

What causes anovulatory AUB?

A

result of endocrinopathy (PCOS)

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18
Q

What is the mechanism of AUB-O

A

unopposed estrogen

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19
Q

What is the bleeding characteristic of AUB-O?

A

Ranges of amenorrhea to irregular heavy cycles

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20
Q

What is endometrosis

A

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

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21
Q

Endometriosis triad?

A

dysmenorrhea, dyspareunia (deep), and dyschezia

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22
Q

What causes endometrosis?

A

not a single theory explains all cases

23
Q

What theory most commonly is used to explain endometriosis?

A

Implantation theory (Retrograde Menstruation)

24
Q

What is the implantation theory?

A

retrograde mensuration, common in women w/ patent fallopian tubes

25
Q

The diagnosis of endometriosis is made by?

A

direct visualization w/ laparoscopy or laparotomy

26
Q

Risk factors for endometriosis?

A

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

27
Q

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

A

NO

28
Q

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

A

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

29
Q

What is the medical treatment for endometriosis?

A

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

30
Q

What is a problem with GnRH agonist?

A

Chemical Menopause

31
Q

How long is the GnRH agonist given?

A

6 months (short duration)

32
Q

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

A

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

33
Q

What drugs are included in the add back therapy?

A
  • Norethindrone acetate 10mg/d
  • Conjugated estrogen 0.3-0.625 w/ Medroxyprogesterone
  • Micronized Estradiol w/ Medroxyprogesterone acetaete
34
Q

What guides the surgical treatment for endometriosis?

A

desire for future fertility

35
Q

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

A

Laparoscopic or open surgery

destroy all endometriotic implants and remove all adhesive disease

36
Q

If patient does not desire future fertility?

A

comprehensive surgery (total abdominal hysterectomy, bilateral salpingoophorectomy)

37
Q

Who is more at risk for endometriosis?

A

White >Blacks or Asian

38
Q

How does retrograde menstruation create endometriosis?

A

fluid spills in the peritoneum and attaches

39
Q

What are women with endometriosis at risk for?

A

endometrium cancer

40
Q

How do endometrium implants look?

A

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

41
Q

Contains thick dark “ chocolate fluid”

A

endometrioma (viewed by sonogram)

42
Q

Minimal endometrium implants have?

A

isolated implants

43
Q

Severe endometrium implants have?

A

multiple implants, large endometriomas, adhesions

44
Q

Mild endometrium implants have?

A

scattered lesions less than 5cm in aggregate, no adhesions

45
Q

Moderate endometrium implants have?

A

multiple implants, adhesions

46
Q

What does PALM-COEIN classify abnormal bleeding by?

A

pattern and etiology

47
Q

Who is at risk for malignancy and hyperplasia in AUB?

A

nulliparity, late menopause, Tamoxifen, obesity

48
Q

What causes abnormal bleeding at birth?

A

estrogen withdrawal

49
Q

Medical therapy for AUB-O?

A

cyclic or continous provera
OCP
NSAID
Tranexamic acid (lysteda)

50
Q

What procedures are done for AUB-O?

A

IUD (Levonorgestrel)

51
Q

Some surgical options for AUB-O?

A

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

52
Q

What is the follow up for AUB?

A

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

53
Q

What should be done in a emergency for AUB?

A

OCP taper
IV estrogen
Tranfusion
Emergent D&C

Women's Health (11 decks)

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