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28 Cards in this Set
- Front
- Back
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What is the definition of DUB? |
1. Abnormal uterine bleeding in the absence of uterine pathology or medical illness
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With what condition is DUB associated? |
1. Anovulation--- unopposed estrogen |
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When should you evaluate menstrual blood flow? |
1. If it lasts longer than 7 days |
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What are the five phases of the menstrual cycle? |
1. Menstrual endometrium phase 2. Proliferative phase 3. Secretory phase 4. Implantation phase 5. Exfoliative phase |
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What are the characteristics of the menstrual endometrium? |
1. Thin dense tissue 2. Stable, non-functioning basalis layer |
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What are the characteristics of the endometrium in proliferative phase? |
1. Glandular growth and reconstruction occurs 2. Marked increase in mitotic activity |
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What are the characteristics of the menstrual cycle during secretory phase? |
1. Endometrial height is stable 2. Vacuoles appear in glandular tissue 3. Increased vessel tortuosity |
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What are the characteristics of the endometrium in implantation phase? |
1. Can see three zones--- 2. Stratum spongiosum 3. Stratum compactum 4. Unchanged basalis |
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What is menorrhagia? |
1. Excessive and prolonged uterine bleeding at regular intervals |
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What is metrorrhagia? |
1. Irregular, intramenstrual bleeding |
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What is menometrorrhagia? |
1. Heavy, prolonged, irregular bleeding at frequent, irregular intervals |
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What is polymenorrhea? |
1. Frequent, regular episodes of uterine bleeding at intervals of less than 21 days |
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What is oligomenorrhea? |
1. Irregular bleeding occurring at prolonged intervals of more than 35 days |
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What is amenorrhea? |
1. Absence of uterine bleeding for 3 normal cycles of 6 months |
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How do you dx DUB? |
1. H&P 2. CBC, hCG, TFT, prolactin, clotting studies 3. LFTs 4. Renal function |
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How do you tx progesterone breakthrough bleeding? |
1. Add estrogen to progesterone-only methods 2. Increase estrogen in combined methods 3. Wait it out |
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What specific type of birth control pill can cause progesterone breakthrough bleeding? How do you tx this? |
1. Extended cycle birth control 2. 3 day pill holiday to tx |
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What imaging modalities can you use to evaluate DUB? |
1. Abdominal/transvaginal US 2. Hysterosalpingography 3. TAKE A SAMPLE OF THE ENDOMETRIAL CAVITY |
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What dx must be excluded in DUB in the perimenopausal patient? |
1. Malignant condition |
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How do you tx DUB? |
1. Progestional agents 2. Estrogen tx 3. OC 4. Antiprostaglandins |
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When is estrogen indicated in the tx of DUB? |
1. Bleeding has been prolonged 2. Insufficient tissue for progestin action |
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When is a low-dose OC indicated in the tx of DUB? |
1. Young anovulatory woman in whom there is prolonged unopposed endogenous estrogen |
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What is the follow-up protocol for DUB |
1. Patient must be followed 2. Chronic involution can lead to further abnormal bleeding |
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How do you control abnormal bleeding in ovulating women with menorrhagia? |
1. NSAIDs 2. Progestin daily for 7 days before menses 3. OCs |
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What is the indication for a D&C in DUB? |
1. 1o tx for patients who are in the second half of reproductive life and are bleeding heavily 2. 2o tx for younger patients |
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What is destroyed in endometrial ablation? |
1. Destruction of basalis layer |
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What is the indication for a hysterectomy? |
1. Anatomic lesions--- fibroids 2. Malignancy 3. Severe premalignant changes |
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What is progesterone breakthrough bleeding? |
1. Continuous progesterone exposure causes a functional atrophy of the endometrial lining which can lead to bleeding |
