GYN- AUB

Question 1

post test probability of endometrial CA for positive test and neg test (EMB)

Answer 1

pos EMB- 81.7%, neg EMB 0.9%
(pos test is more accurate for ruling in disease than neg test is for ruling out

Question 2

when should you perform EMB

Answer 2

patients with AUB who are 45 and older as first line. perform younger than 45 w/ hx of unopposed estrogen (obesity or PCOS), failed medical management, persistent AUB

Question 3

how much of the endometrium does EMB sample

Answer 3

on average, 4% with range of 0-12%

Question 4

sensitivity of EMB

Answer 4

68-78%
68% in studies that used hyst as reference, 78% in studies that used D&C as references

Question 5

absolute contraindications to endometrial ablation

Answer 5

pregnancy
known or suspected endometrial hyperplasia or cancer
desire for future fertility
active pelvic infection
IUD in situ
post menopausal
avoid in: congenital uterine anomalies, severe myometrial thinning, uterine cavity lengths that exceed capacity of device (10-12 cm)

Question 6

how effective is endometrial ablation

Answer 6

25% have hyst within 5 yars
30-40% amenorrhea at 1 year
50% amenorrhea at 2-5 years after

Question 7

what is post ablation tubal sterilization syndrome

Answer 7

cyclic pelvic pain due to residual active endometrium near cornua leading to obstructed hematometra

Question 8

postmenopausal women with insufficient tissue (sampling failure)

Answer 8

20% have uterine pathology, 3% have endometrial CA

Question 9

TXA MOA

Answer 9

Lysteda
-Binds to lysine binding site on tissue plasminogen activator, reduced plasmin lysis of fibrin to fibrin degradation products (antifibrinolytic), stabilizing intrauterine clot
-reduced bleeding by 50%

Question 10

mechanism for AUB-O

Answer 10

estrogen breakthrough bleeding. No dominant follicle, no corpus luteum, therefore no progesterone. No luteal progesterone to stabilize endometrium. No progestin withdrawal bleed to organize sloughing. Endometrium outgrows blood supply then have bleeding. Treat with progesterone.

Question 11

ovarian failure rates after UAE

Answer 11

12-18% (similar to hysterectomy)
Higher rates of pregnancy loss, CD, and PPH

Question 12

What is elagolix and what is it used for

Answer 12

GnRH antagonist, used for bleeding sx of fibroids. 200 mg BID x6 months or 150 mg qd for 2 years. Give hormonal add back (1 mg estradiol/0.5 mg norethindrone).
FDA approved for 2 y
SE: hot flushes and headache

Question 13

Surgical fibroid treatment options

Answer 13

Myomectomy
UAE
Radio frequency ablation
Endometrial ablation
MRI guided US surgery