Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
35 Cards in this Set
- Front
- Back
DEFINITION of Abnormal uterine bleeding-
|
Any significant deviation from the usual menstrual pattern
|
|
DEFINITION of DUB
|
DUB- Excessive, prolonged, noncyclic bleeding from endometrium in the absence of organic uterine pathology. (Not caused by pelvic pathology, meds, pregnancy or systemic disease).
|
|
Menorrhagia or hypermenorrhea-
|
prolonged or excessive bleeding at regular intervals. (usually > 7 days) or > 80 ml.
Increases with age especially perimenopausal women |
|
Hypomenorrhea
|
shorter menses or less flow per day.
|
|
Menometrorrhagia
|
prolonged or excessive bleeding at irregular intervals.
|
|
Polymenorrhea-
|
less than 21 days between cycles. (Luteal phase dysfunction
|
|
Metrorrhagia-
|
bleeding pattern that occurs at irregular times, but is not excessive.
|
|
Oligomenorrhea-
|
more than 35 days between cycles.
is a follicular phase dysfunction (prolonged |
|
Amenorrhea
|
no bleeding for at least 3 cycle intervals or 6 months.
|
|
Primary amenorrhea:
|
absence of menarche by 15 years old without secondary sex characteristics: 17 years old with secondary sex characteristics.
|
|
Secondary amenorrhea:
|
loss of menses in women with previous cycles.
|
|
Chronic AUB
|
present for more than 6 months
|
|
Acute AUB
|
requires immediate intervention.
|
|
Intermittent AUB
|
occurs between otherwise regular cycles.
|
|
Acronym for AUB
|
PALM-COEIN
|
|
PALM-COEIN
|
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 |
|
How much of total flow of a menstrua cycle consitutes blood?
|
50%
|
|
NORMAL MENSTRUAL CYCLE
|
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. |
|
3 phases of a normal menstrual cycle
|
follicular, ovulatory and luteal phases
|
|
CAUSES OF ANOVULATORY BLEEDING
|
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 |
|
SIGNS AND SYMPTOMS of anovulatory bleeding
|
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. |
|
What is Postmenopausal bleeding
|
– 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.
|
|
What 3 SSRIs pose the highest risk of bleeding?
|
prozac, paxil, and zoloft.
|
|
What physical exam finding is the Hallmark of DUB ?
|
A negative pelvic exam
|
|
Labs for irregular bleeding
|
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. |
|
What does Saline infusion sonohysterography- detec?
|
detects polyps, submucous fibroids and uterine malformations.
|
|
What is a Hysteroscopy used to evaluate?
|
endometrial polyps, submucosal fibroids, or other endometrial abnormalities.
|
|
What does a Hysterosalpingogram detec?
|
structural abnormalities.
|
|
What is the gold standar for dx endometrial ca?
|
D and C-
not considered therapeutic for AUB. |
|
In DUB what will endometrial bx show?
|
nonsecretory endometrium
|
|
B recommendation for irregular bleeding
|
OCPs
|
|
Most effective tx for menorrhagia
|
Mirena IUD
|
|
What is required in any post menopausal women who experiences bleeding and is not using HRT?
|
An endometrial biopsy
|
|
LUTEAL PHASE INSUFFICIENCY
|
Main symptom is polymenorrhea or “menstrual periods every 2 weeks”.
|
|
What is a B recommnedation for tx of ovulatory DUB?
|
NSAIDS
|