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AUB Flashcards

1
Q

Classification of abnormal uterine

bleeding

A

Abnormal rhythm
Abnormal amt
Combination (rhythm and amount)

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2
Q 
Abnormal rhythm bleeding examples
1
2
3
4
A

Irregularity of cycle
Intermenstrual bleeding (metrorrhagia)
Postcoital bleeding
Postmenopausal bleeding

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3
Q

Abnormal amount example

Increased amount = ______
Decreased amount =_______

A

menorrhagia

hypomenorrhoea

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4
Q

Combination (rhythm and amount)

Irregular and heavy periods = _____
Irregular and light periods =_______

A

metromenorrhagia

oligomenorrhoea

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5
Q

Up to _____ of women in the reproductive age

group complain of increased menstrual loss

A

20%

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6
Q

The mean blood loss in a menstrual cycle is

________

A

30–40 mL

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7
Q

Heavy menstrual bleeding (menorrhagia)—

HMB—is a menstrual loss of more than______

A

80 mL per

menstruation

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8
Q

Two common organic causes of HMB are _____ and ______

A

fibroids
and adenomyosis (presence of endometrium in the
uterine myometrium

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9
Q

Most girls reach menarche by the age of ________

A

13 (range 10–16 years).

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10
Q

Dysfunctional bleeding
is common in the first ______ after menarche due
to many anovulatory cycles resulting in irregular
periods, heavy menses and probably dysmenorrhoea

A

2–3 years

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11
Q

A normal endometrial thickness, as measured by

ultrasound, is between_______

A

6 and 12 mm

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12
Q

The menstrual
cycle is confirmed as being________(biochemically)
if the serum progesterone (produced by the corpus
luteum) is >20 nmol/L during the mid-luteal phase
(5–10 days before menses).

A

ovulatory

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13
Q

The incidence of malignant disease as a cause of bleeding increases with age, being greatest after the age of _________ while endometrial cancer
is predicted to be less than 1 in 100 000 in women
under the age of 3

A

45,

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14
Q

Dysfunctional
uterine bleeding is more common in the extremes of the
reproductive era, while the incidence of cancer as a
cause of bleeding is greatest in the _____ and _____

A

perimenopausal and

postmenopausal phases.

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15
Q

What is HMB

A
  • blood loss >80 mL per menstrual cycle
  • bleeding that persists >7 days
  • bleeding that is unacceptable to the woman
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16
Q

Menorrhagia 4 is essentially caused by excessive local
production of ______in the endometrium
and myometrium and/or excessive _______

A

prostaglandins

local fibrinolytic activity.

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17
Q

By far the most common single ‘cause’ of

menorrhagia is ______

A

ovulatory dysfunctional uterine

bleeding (DUB).

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18
Q

_______ occurs at the
extremes of the reproductive period—around
menarche and perimenopausall

A

Anovulatory DUB

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19
Q

MCC of Anovulatory DUB

A

fibromyomatas (fibroids),endometriosis, adenomyosis (‘endometriosis’ of the
myometrium), endometrial polyps and PID

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20
Q

__________reserved for women who fail
conservative treatment or who are at increased risk
of endometrial cancer

A

UTZ

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21
Q

When to request biopsy in UTZ

A

If it is >12 mm for premenopausal women
or >5 mm for perimenopausal women, endometrial
biopsy (with or without hysteroscopy) is indicated

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22
Q

____ and _______remain the

gold standard for abnormal uterine bleeding.

A

Hysteroscopy and D&C

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23
Q

______excessive bleeding, whether heavy, prolonged or
frequent, of uterine origin, which is not associated
with recognisable pelvic disease, complications of
pregnancy or systemic disease

A

DUB

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24
Q

DUB is MC in what cycle?

A

It is more common in ovulatory
(regular) rather than anovulatory (irregular)
cycles.

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25
Q

Peak incidence of ovulatory DUB in late_____

A

30s and 40s (35–45 years).

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26
Q

_______DUB has two peaks: 12–16
years and 45–55 years. The bleeding is
typically irregular with spotting and variable
menorrhagia

A

Anovulatory

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27
Q

The serum progesterone and the pituitary
hormones___ and ______ will confirm
anovulation

A

(LH and FSH)

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28
Q

DUB Tx

_________ is usually employed
if the uterus is of normal size and there is no
evidence of anaemia

A

Conservative management

29
Q

Consider surgical management if____ and _____

A

fertility is
no longer important and symptoms cannot be
controlled by at least 3–4 months of hormone
therapy

30
Q

Mx of acute heavy bleeding

A

• oral high-dose progestogens (e.g. norethisterone
5–10 mg 4 hourly until bleeding stops then 5 mg bd
or tds for 14 days

31
Q

MX of chronic bleeding

For anovulatory women:

A
  • cyclical oral progestogens for 12 days

* tranexamic acid

32
Q

MX of chronic bleeding

For ovulatory women:

A

• cyclical prostaglandin inhibitor (e.g. mefenamic acid)
or (one of)
• oral contraceptive
• antifibrinolytic agent (e.g. tranexamic acid 1 g (o) qid,
days 1–4)
• progesterone-releasing IUDs (e.g. Mirena

33
Q

The agent of first choice in DUB is usually
________, which reduces blood loss by 20–25%
as well as helping dysmenorrhoea

A

mefenamic acid

34
Q

Hormonal agents for DUB include
1
2
3

A

progestogens, combined
oestrogen–progestogen oral contraceptives and
danazol.

35
Q

The_______constitutes important first-line
therapy in both ovulatory and anovulatory patients,
but at least 20% of patients do not respond

A

COC

36
Q

In the adolescent with anovulatory DUB, __________ may be required for 6 months
until spontaneous regular ovulation eventuates

A

cyclical

oral progestogens

37
Q

The most effective agent for both ovulatory and
anovulatory DUB is tranexamic acid, which inhibits
___________

A

endometrial plasminogen activation

38
Q

Dose of Tranex for DUB

A

The dose is 1 g

(up to 1.5 g if necessary) orally qid for the first 4 days

39
Q

It is regarded
as the most efficacious of the hormone treatments
with a mean blood loss of 94% of women with
menorrhagia.

A

The intra-uterine progesterone implant system

Mirena

40
Q

Sx Mx

• endometrial ablation or electrodiathermy
excision—to produce _________

A

amenorrhoea

41
Q

It is preferred to drug
therapy for women with endometrial hyperplasia
with atypia—endometrial ablation is not
appropriate

A

hysterectomy

42
Q 
Emergency menorrhagia (acute flooding) 4
First line
A

• tranexamic acid 10 mg/kg IV, every 8 hours until
bleeding stops
or
• tranexamic acid 1–1.5 g (o) 6 to 8 hourly until
bleeding stops

43
Q

If above unavailable or not tolerated, other options

are:

A

• norethisterone 5–10 mg 4 hourly (o) till bleeding
stops, then 5 mg bd or tds (or 10 mg daily) for
14 days
or
• medroxyprogesterone acetate 10 mg (o) 4 hourly
until bleeding stops for 7 days then 20 mg daily
for 21 days
or
• COCP e.g. until bleeding stops then re-evaluate
after 48 hours

44
Q

General guidelines for surgical intervention

A
  • no longer wish to be able to conceive
  • are perimenopausal
  • have poorly controlled symptoms
  • have adverse effects from the drugs
  • have significant uterine pathology
45
Q

Patients under 35 years:

Cause of cycle irreg

A

• the cause is usually hormonal, rarely organic, but

keep malignancy in mind

46
Q

management options for cycle irreg in under 35

A

— explanation and reassurance (if slight
irregularity)
— COC pill for better cycle control—any pill can
be used
— progestogen-only pill (especially anovulatory
cycles) norethisterone (Primolut N)
5–15 mg/day from day 5–25 of cycle

47
Q

MCC of Intermenstrual bleeding

and postcoital bleeding

A

factors such as
cervical ectropion (often termed cervical erosion),
cervical polyps, the presence of an IUCD and the oral
contraceptive pill.

48
Q

Cervical ectropion, which is commonly found
in women on the pill and postpartum, can be left
untreated unless _____ and ______

A 
intolerable discharge or moderate
postcoital bleeding (PCB) is present
49
Q

________ are benign tumours of smooth muscle of the

myometrium

A

Fibroids

50
Q 
Pelvic ultrasound (investigation of choice) .
Endometrial thickening >4 mm demands
\_\_\_\_\_\_\_\_ If >7 mm, \_\_\_\_\_\_\_\_
A

endometrial sampling.

endometrial cancer should be excluded

51
Q

Med Mx of uterine fibroids

• Consider COCP (30 mcg oestrogen can reduce
bleeding

_________—especially if >42 years can
shrink fibroids (maximum 6 months)—use only
immediately pre-operative

A

• GnRH analogues

52
Q

Sx Mx of fibroids

A 
— myomectomy (remove fibroids only, esp.
child-bearing years)
— hysteroscopic resection/endometrial
ablation
— hysterectomy
53
Q

This should be the diagnosis until proved otherwise
for postcoital, intermenstrual or postmenopausal
bleeding

A

Cervical CA

54
Q

MC Sx of cervical CA

A
  • Postcoital bleeding
  • Intermenstrual bleeding
  • Vaginal discharge—may be offensive
55
Q

PE of cervical CA

A
  • Ulceration or mass on cervix

* Bleeds readily on contact—may be friable

56
Q

This is the diagnosis until proved otherwise in any

woman presenting with postmenopausal bleeding.

A

Endometrial cancer

57
Q

T or F
Endometrial cancer is not excluded by a
normal cervical smear

A

T

58
Q

Primary amenorrhoea is the failure of the menses

to start by _______

A

16 years of age

59
Q

Secondary amenorrhoea is

the absence of menses for over______

A

6 months in a woman

who has had established menstruation

60
Q

The main approach in the patient with primary
amenorrhoea is to differentiate it from ________ in which there are no signs of sexual
maturation by age

A

delayed

puberty,

61
Q

Amenorrhea

It is important to keep in mind
the possibility of an ____ and _______, which can suppress hypothalamic
GnRH production.

A

imperforate hymen and also

excessive exercise

62
Q 
Causes of primary amenorrhoea include 
1
2
3
4
5
A

genital
malformations, ovarian disease, pituitary tumours,
hypothalamic disorder and Turner syndrome

63
Q

Diagnostic tests for amenorrhea include

A

serum FSH, LH, prolactin,

oestradiol and also chromosome analysis.

64
Q 
In secondary amenorrhoea, consider a
physiological cause such as 
1
2
3
A

pregnancy or the menopause, failure of some part of the hypothalamic–
pituitary–ovarian–uterine axis (e.g. PCOS) or a
metabolic disturbance

65
Q

_________is the term for infrequent
and usually irregular periods, where the cycles are
between 6 weeks and 6 months

A

Oligomenorrhoea

66
Q

Premature ovarian failure

Apart from iatrogenic causes this may be caused by
idiopathic early menopause and _______

A

autoimmune ovarian

failur

67
Q

Remember that ____can obscure the

organic causes of menorrhagia

A

mental dysfunction

68
Q

_______is more effective than the traditional
curettage. Studies have shown that usually less
than 50% of the uterine cavity is sampled by
curettage.

A

Hysteroscopy

MC (90 decks)

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