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abnormal bleeding Flashcards

1
Q

Menorrhagia

A

hypermenorrhea): prolonged duration of menses (>7 days) and/or increased amount of bleeding (>80mL) occurring at regular intervals

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2
Q

Hypomenorrhea:

A

unusually scanty menstrual bleeding lasting for less than 2 days; menses occur at regular intervals

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3
Q

Metrorrhagia:

A

uterine bleeding at irregular intervals, particularly between expected menstrual periods

Bleeding between periods

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4
Q

Menometrorrhagia

A

uterine bleeding that is prolonged and completely irregular

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5
Q

Polymenorrhea

A

frequent but regular menstrual cycles (<21 days

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6
Q

Oligomenorhea:

A

regular but prolonged menstrual cycles (>35 days)

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7
Q

Amenorrhea:

A

no menstrual bleeding for at least 3 cycles or 6 months

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8
Q

Postmenopausal bleeding (PMB):

A

uterine bleeding that occurs more than 12 months after the last menstrual period

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9
Q

Postcoital bleeding

A

vaginal bleeding during or after intercourse

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10
Q

Dysmenorrhea

A

painful menses

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11
Q

Anovulatory bleeding:

A

uterine bleeding that is not associated with ovulation

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12
Q

Dysfunctional uterine bleeding (DUB):

A

abnormal uterine bleeding with no demonstrable organic cause; a diagnosis of exclusion

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13
Q
  • Normal menses should be about every
A

every 21-35 days

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14
Q

– Variability in more than______ is considered irregular

A
  • Variability in more than 20 days is considered irregular
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15
Q

 VulvoVaginal causes of bleeding

A 
	Trauma
	Cancer
	Atrophy
	Infection
	Benign growths
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16
Q

 Ectropion can cause what kind of bleeding

A

causes post coital bleeding

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17
Q

 Polyps can cause what kid of bleeding

A

causes post coital bleeding

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18
Q

causes of uterine bleeding

A 
DUB
Leiomyoma; structural abnormalities
ectopic 
ovulatory dysfunction
bleeding disorder
infection 
endometrial cancer
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19
Q

ovarian or adnexal causes of bleeding

A 
salpingitis PID 
ovarian cancer (VERY UNUSUAL)
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20
Q

structural causes

A

i. Polyp, Adenomyosis, Leiomyoma, Malignancy & hyperplasia

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21
Q

bleeding in post menopause

A

uterine ca

22
Q

neonates vaginal bleeding

A

estrogen w/d 30 days

23
Q

precocious puberty

A

early as 8

24
Q

post menopausal causes of bleeding

A

HRT
endometrial CA
atrophy (5 or 6 years post menopause)

25
PALM COING
non gravid reproductive age causes of bleeding polyp adenomyosis leiomyoma malignancy and hyperplasia unrelated to structure ``` coagulopathy ovulatory dysfunction endometrial iatrogenic not yet classified ```
26
liver or renal disease
can cause these problems as well
27
cervical cytology results that would indicate the need for EMB
AGC of the endometrium (high risk) ACG of all other categories if >35 or have other risk factos' bleeding in women >40
28
Associated molimenol sx in a pt with irregular bleeding you would think
(breast tenderness, cramping, moody, etc) – | suggest ovulatory cause
29
quantitative pregnancy | test
allows you to see what is happening over time via hcg
30
45 yo G3P3 female c/o heavy, prolonged menstrual bleeding x 4-6 mos. BTL 5 yrs ago. No meds, NKDA. She is using 8-10 tampons/day for 5-7 days and her cycles are 21-25 days in length. This is increased from baseline of 3-4 tampons/day for 3-5 days and 28-30 day cycles for 20+ years. All pregnancies uncomplicated. No PMH; FH noncontributory. DDX
perimenopause Polyps Adenomyosis Leiyoma Malignancy ``` Coagulopathy Ovulatory dysfunction Enodemtium Iantrogenic Not yet classified ``` hypothyroidism
31
adenomyosis
Islands ofendometrial tissue within the myometrium (muscular layer of the uterine wall).
32
sxs of adenomyosis
Menorrhagia (progressively worsens), dysmenorrhea, infertility. symmetric soft tender
33
physical exam with adenomyosis
(uniformly)enlarged"boggyuterus"* | "globular" enlargement.
34
adenomyosis vs endometriosis
endometriosis is outside of the uterus adenomyosis is in the uterine wall
35
endometritis
post partum fever vaginal discharge PID more typical in younger women
36
endometrial polyp is associated with
mertorrhagia
37
non tender mobile uterus
most likely benign fibroids
38
when do you send pts to the ER for anemia
hgb <10 or sxs can also send pt to blood bank
39
MC pelvic tumor and MCC of hevay vaginal bleeding
leyomyomas myomas or fibroids made from smooth muscle cells
40
DUB dx by
ovulatory or anovulatory
41
tx of acute bleed
usually avoid medoxyprogesterone (Provera) micornized progestrone is safer but you can use either Provera (MPA)20 mg PO QD x10 days or Prometrium 200 mg x 14 days both of these organize the endometrium
42
Moderate bleeding >3 days:
monophasic oral contraceptive BID-TID x 5-7 days
43
extreme bleeding DUB tx
inpatient ``` Conjugated Estrogen (Premarin) 25 mg IV Q6H x 4 doses, then progesterone or surgical curettage ```
44
reoccurent DUB tx
OCP one tablet per day for 21 days better to use IUD OR intermitten progesterone therapy Medroxyprogesterone acetate 10mg daily, Day1-10 of each month/cycle
45
Most common cause of DUB in adolescents
Anovulatory Cycles
46
Responses to anovulation
amenorrhea estrogen withdrawal bleeding estrogen breakthrough bleeding: stromal crowding heavy (menorrhagia) or irregular (metrorrhagia) bleeding
47
tx of DUB in immature HPO axis
Progestin therapy 10 days every month or every other until full maturity of the axis provides effective therapy Low dose OCP’s Progestin therapy does not interfere with the normal progression to spontaneous ovulatory cycles.
48
Perimenopausal Women DUB needed
``` Endometrial biopsy (EMB) Endovaginal ultrasound (endometrial stripe < 5mm) Saline ultrasound (SIS) ```
49
TX of DUB in perimeno woman
Atrophic vaginitis: Topical estrogen Endometrial atrophy: due to hypoestrogenism resulting in thinning of surface that is prone to bleeding Endometrial hyperplasia: continuous bleeding Progesterone x 3-6 months, then re-biopsy Tri-cyclic or continuous HRT
50
post coital bleed DDX
``` Endocervical infection (GC,Chlamydia) Cervical or vaginal warts Friable ectropion Neoplasia (invasive): Vaginal, cervical, endocervical, or endometrial Endometritis (acute or chronic) Polyp: Endocervical or endometrial Vaginal foreign body Urethral lesion ```
51
endometrial ablation requires
Requires normal EMB and negative pregnancy test Not effective if submucosal fibroids

GYN (13 decks)

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