#128 Diagnosis of Abnormal Uterine Bleeding in Reproductive-Aged Women

Question 1

How long does the normal menstrual cycle last (time between)

Answer 1

21 to 35 days

Question 2

What is the definition of heavy menstrual bleeding

Answer 2

Great than 80mL (research), clinically based on patient perception

Question 3

What is menorrhagia

Answer 3

heavy menstrual bleeding

Question 4

What is metrorrhagia

Answer 4

Bleeding between periods

Question 5

What is polymenorrhea

Answer 5

Bleeding that occurs more often than every 21 days

Question 6

What is oligomenorrhea

Answer 6

Bleeding that occurs less frequently than every 35 days

Question 7

What percentage of women presenting at any age with HMB will have an underlying bleeding disorder

Answer 7

up to 20%

Question 8

What herbal remedies can cause AUB?

Answer 8

Ginkgo, ginseng, motherwort

Question 9

Which patients w/ HMB should be tested for underlying disorder of hemostasis?

Answer 9

-HMB since menarche
- PP hemorrhage
- Surgery-related bleeding
- Bleeding associated with dental work
Two or more of the following:
- bruising 1-2x/mo
- epistaxis 1-2x/mo
- frequent gum bleeding
- FH of bleeding symptoms

Question 10

What are physical exam findings suggestive of a bleeding disorder?

Answer 10

Petechiae, ecchymoses, skin pallor, swollen joints

Question 11

What is the name of the test for von Willebrand disease?

Answer 11

von Willebrand-ristocetin cofactor activity, von Willebrand factor antigen, and factor VIII

Question 12

Is hypothyroidsim or hyperthyroidism associated with AUB?

Answer 12

Both are, but hypothyroidism is more common

Question 13

What are the imaging modalities used to evaluate AUB?

Answer 13

Primary imaging test TVUS. Then SIS of hysteroscopy to better evaluate uterine cavity. MRI is not a primary imaging modality for AUB.

Question 14

How many adolescents with AUB who require hospitalization have an underlying coagulopathy?

Answer 14

As many as 19%

Question 15

What is the sensitivity of TVUS for detecting intracavity pathology?

Answer 15

56%

Question 16

What percentage of women with AUB have intrauterine abnormalities?

Answer 16

46.6%

Question 17

When should endometrial tissue sampling be performed in patients with AUB?

Answer 17

Patients with AUB who are older than 45 years, or younger than 45 years with a history of unopposed estrogen exposure, failed medical management, and persistent AUB.

Question 18

What is the concern of EMB with a focal lesion?

Answer 18

If the cancer occupies less than 50% of the surface area of the endometrial cavity, blind biopsy may miss it

Question 19

What is the chance of endometrial cancer with a negative EMB?

Answer 19

0.9%

Question 20

What does persistent bleeding after benign EMB necessitate?

Answer 20

Further work up

Question 21

What ultrasound findings support a diagnosis of adenomyosis?

Answer 21

Heterogeneous myometrium, myometrial cysts, asymmetric myometrial thickness, and subendometrial echogenic linear striations

Question 22

How is adenomyosis best visualized?

Answer 22

T2-weighted MRI

Question 23

Is ultrasound or MRI better at detecting adenomyosis?

Answer 23

MRI is equal to better than ultrasound. MRI performs better with coexisting myomas.

Question 24

When is treatment for AUB appropriate?

Answer 24

Trial of therapy is appropriate when risk for hyperplasia, neoplasia, or structural abnormalities is low. For those at increased risk, >45, initiation of therapy is appropriate after diagnostic evaluation