Abnormal And Dysfunctional Uterine Bleeding

Front 1

DEFINITION of Abnormal uterine bleeding-

Back 1

Any significant deviation from the usual menstrual pattern

Front 2

DEFINITION of DUB

Back 2

DUB- Excessive, prolonged, noncyclic bleeding from endometrium in the absence of organic uterine pathology. (Not caused by pelvic pathology, meds, pregnancy or systemic disease).

Front 3

Menorrhagia or hypermenorrhea-

Back 3

prolonged or excessive bleeding at regular intervals. (usually > 7 days) or > 80 ml.
Increases with age especially perimenopausal women

Front 4

Hypomenorrhea

Back 4

shorter menses or less flow per day.

Front 5

Menometrorrhagia

Back 5

prolonged or excessive bleeding at irregular intervals.

Front 6

Polymenorrhea-

Back 6

less than 21 days between cycles. (Luteal phase dysfunction

Front 7

Metrorrhagia-

Back 7

bleeding pattern that occurs at irregular times, but is not excessive.

Front 8

Oligomenorrhea-

Back 8

more than 35 days between cycles.
is a follicular phase dysfunction (prolonged

Front 9

Amenorrhea

Back 9

no bleeding for at least 3 cycle intervals or 6 months.

Front 10

Primary amenorrhea:

Back 10

absence of menarche by 15 years old without secondary sex characteristics: 17 years old with secondary sex characteristics.

Front 11

Secondary amenorrhea:

Back 11

loss of menses in women with previous cycles.

Front 12

Chronic AUB

Back 12

present for more than 6 months

Front 13

Acute AUB

Back 13

requires immediate intervention.

Front 14

Intermittent AUB

Back 14

occurs between otherwise regular cycles.

Front 15

Acronym for AUB

Back 15

PALM-COEIN

Front 16

PALM-COEIN

Back 16

P – endometrial polyps
A – adenomyosis
L – leiomyomas (fibroids – usually submucosal)
M – malignancy, including hyperplasia and endometrial cancer
C – coagulopathy
O – ovulatory dysfunction
E – endometrial problems
I – iatrogenic causes
N – nonclassified causes

Front 17

How much of total flow of a menstrua cycle consitutes blood?

Back 17

50%

Front 18

NORMAL MENSTRUAL CYCLE

Back 18

Between 21 and 35 days
2-7 days of bleeding
Blood loss of 35 -80 ml per cycle, equivalent to approx 8 soaked pads or 18 regular tampons.
Clots < or = a quarter in size.
Maxipad holds 5-15 ml of blood, regular tampon 5 ml.
Changing a saturated pad or tampon more than once/hour are predictive of menorrhagia.

Front 19

3 phases of a normal menstrual cycle

Back 19

follicular, ovulatory and luteal phases

Front 20

CAUSES OF ANOVULATORY BLEEDING

Back 20

Most often caused by hormonal imbalance
Excess estrogen (unopposed)
Excess androgen: PCOS; acute stress (conversion of adrenal androgen to estrone).
Excess prolactin: hyperprolactinemia may cause anovulation before frank amenorrhea.
Hypothalamic anovulation – Weight loss, eating disorders, stress, or excessive exercise, chronic illness.
Age-related: Peri-menarche and peri-menopause.
All causes represent a progesterone deficient state

Front 21

SIGNS AND SYMPTOMS of anovulatory bleeding

Back 21

Irregular menses or spotting between periods.
Heavy, painless bleeding with periods of amenorrhea.
Prolonged menses.
Intermenstrual bleeding.
> 3 soaked pads or 6 regular tampons/day for 3 or more days.
Periods lasting 7-18 days.

Front 22

What is Postmenopausal bleeding

Back 22

– AUB that occurs 12 months or more after cessation of menses or unpredictable bleeding in PM women who have been receiving HT for 12 mos or more.

Front 23

What 3 SSRIs pose the highest risk of bleeding?

Back 23

prozac, paxil, and zoloft.

Front 24

What physical exam finding is the Hallmark of DUB ?

Back 24

A negative pelvic exam

Front 25

Labs for irregular bleeding

Back 25

TSH – B recommendation with irregular bleeding or menorrhagia.
Pap – if PCB and no polyps.
Prolactin – if galactorrhea, oligomenorrhea or hypomenorrhea.
Bleeding studies if suspect Von Willebrand’s, esp in adolescents.
Progesterone level - determines ovulatory cycle.
LFT’s – if alcoholism or hepatitis suspected – estrogen metabolized in liver.

Front 26

What does Saline infusion sonohysterography- detec?

Back 26

detects polyps, submucous fibroids and uterine malformations.

Front 27

What is a Hysteroscopy used to evaluate?

Back 27

endometrial polyps, submucosal fibroids, or other endometrial abnormalities.

Front 28

What does a Hysterosalpingogram detec?

Back 28

structural abnormalities.

Front 29

What is the gold standar for dx endometrial ca?

Back 29

D and C-
not considered therapeutic for AUB.

Front 30

In DUB what will endometrial bx show?

Back 30

nonsecretory endometrium

Front 31

B recommendation for irregular bleeding

Back 31

OCPs

Front 32

Most effective tx for menorrhagia

Back 32

Mirena IUD

Front 33

What is required in any post menopausal women who experiences bleeding and is not using HRT?

Back 33

An endometrial biopsy

Front 34

LUTEAL PHASE INSUFFICIENCY

Back 34

Main symptom is polymenorrhea or “menstrual periods every 2 weeks”.

Front 35

What is a B recommnedation for tx of ovulatory DUB?

Back 35

NSAIDS