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Oral board studying Prep book > Office- Abnormal uterine bleeding/Infertility > Flashcards

Office- Abnormal uterine bleeding/Infertility Flashcards

1
Q

What are the causes of abnormal uterine bleeding?

A

Structural causes
P-Polyp
A- Adenomyosis
L- Leiomyoma
M- Malignancy/hyperplasia

Non structural causes
C- Coagulopathy
O- Ovulatory dysfunction
E- Endometrial
I- Iatrogenic
N- Not yet classifies

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2
Q

What is the most common differential for abnormal uterine bleeding in age group of 13-18?

A
  1. HPA axis immaturity- Anovulation
  2. Pregnant
  3. Infection
  4. Bleeding disorders- coagulopathies
  5. Tumors
  6. Hypothalamic dysfunction- stress, eating disorders, excess exercise
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3
Q

What is the most common differential for abnormal uterine bleeding in age group 19-39?

A
  1. Pregnancy
  2. Fibroids/polyps
  3. Hyperplasia/Malignancy
  4. Anovulation- PCOS
  5. Hormonal contraceptives
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4
Q

What are the most common differential diagnoses for abnormal uterine bleeding in age group 40 years and above?

A
  1. Malignancy/hyperplasia
  2. Fibroids/polyps
  3. Anovulation- declining ovarian function
  4. Atrophy
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5
Q

How do you evaluate abnormal uterine bleeding?

A
  1. Medical history
  2. Physical exam
  3. Lab workup
    - hcg, CBC, TSH, cervical cultures, PT/PTT, endometrial biopsy
  4. Imaging
    - Transvaginal ultrasound, sonohysterogram, hysteroscopy, MRI
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6
Q

When is endometrial sampling indicated for abnormal uterine bleeding?

A
  1. Women >45 with AUB
  2. Women <45 with risk factors
    - unopposed estrogen
  3. Women who fail medical management of AUB
  4. Women with persistent AUB
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7
Q

What is the treatment for abnormal uterine bleeding?

A

HMB= OCPs, NSAIDS, TXA, IUD
Anovulation= OCPs, MPA, IUD
Acute and severe bleeding= IV estrogen, OCP taper, D&C
Chronic bleeding= endometrial ablation, UAE, hysterectomy

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8
Q

What is premenstrual syndrome?

A

A combination of physical and emotional symptoms women get after ovulation and before onset of menses

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9
Q

What is premenstrual dysphoric disorder?

A

Severe form of premenstrual syndrome with physical and emotional symptoms present after ovulation and with a few days of menstrual cycle.

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10
Q

What is the treatment for PMDD?

A

Dietary changes
- reducing caffeine, alcohol, salt, fat
- increasing vitamin B6, Ca/Mg, exercise, stress reduction
Medications:
- diuretics, SSRI, Danazol, GnRH agonists

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11
Q

What is galactorrhea?

A

Bilateral milky nipple discharge

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12
Q

What stimulates prolactin?

A

TRH
Nipple stimulation

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13
Q

What inhibits prolactin?

A

Dopamine
Prolactin inhibitory factor

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14
Q

What is the workup for galactorrhea?

A

Medication history
Breast exam
Prolactin level
TSH
Visual field test
MRI of pituitary fossa

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15
Q

How do you treat galactorrhea?

A

dopamine agonist
Cabergoline
Bromocriptine 2.5mg BID

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16
Q

When do you start workup for infertility?

A

Any time if there is anovulation or history of male infertility
or
<35: after 12 months of attempting
>35: after 6 months of attempting

17
Q

What is the workup for infertility?

A
  1. Medical history
    - Assess menses
    - confirm adequate intercourse
    - PMH
    - FH
  2. Workup
    - Midluteal progesterone
    - Test tubal status with HSG, laparoscopy
    - Test semen
    - Ovarian reserve testing if >35
18
Q

How long does it take for ovulation after LH surge?

A

36 hours

19
Q

How long does it take for ovulation after LH peak?

A

12 hours

20
Q

What things can decrease your ovarian reserve?

A

Age>35
Smoking
Ovarian surgery
History of chemo
Family history of early menopause
Genetic condition

21
Q

What is the dose of clomiphene?

A

Dose 50mg x 5 days starting on Day 5 of cycle

22
Q

How does clomiphene work?

A

anti estrogen
Competes for estrogen binding receptors with minimal stimulation

Ovulation takes place 5-10 days after last pill.

Instruct to start intercourse every day or every other day 5 days after last pill

23
Q

What are the side effects of clomiphene?

A

Headache
Dizzy
blurred vision

24
Q

What is the dose of letrozole?

A

2.5mg/day for 5 days starting day 3 of cycle

25
Q

How does letrozole work?

A

Aromatase inhibitor

Blocks synthesis of estrogen which reduces feedback at pituitary level

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