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Obstetric And Gynaecology > Abnormal Uterine Bleeding 1 > Flashcards

Abnormal Uterine Bleeding 1 Flashcards

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1
Q

What is abnormal uterine bleeding (AUB)?

A

A bleeding pattern not consistent with normal menstrual cycle parameters (frequency, regularity, duration, and volume).

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2
Q

How can objective assessment of AUB be done?

A

Through menstrual diaries.

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3
Q

What classification system is used for AUB causes?

A

The PALM-COEIN system.

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4
Q

What are the two main categories of causes for AUB in the PALM-COEIN classification?

A
  • Structural causes (PALM)
  • Nonstructural causes (COEIN)
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5
Q

What does amenorrhea refer to?

A

Absence of menses.

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6
Q

Define oligomenorrhea.

A

Infrequent and irregularly timed episodes of bleeding usually occurring at intervals of >35 days.

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7
Q

Define polymenorrhea.

A

Very frequent episodes of bleeding usually occurring at intervals of <21 days.

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8
Q

What is metrorrhagia?

A

Irregularly timed episodes of bleeding superimposed on normal cyclical bleeding.

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9
Q

What is hypermenorrhea (menorrhagia)?

A

Regularly timed episodes of bleeding that are excessive in amount (>80mL) and/or duration (>7 days).

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10
Q

What does hypomenorrhea refer to?

A

Regularly timed but scanty episodes of bleeding.

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11
Q

What is menometrorrhagia?

A

Excessive and prolonged bleeding that occurs at irregularly times and frequent intervals.

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12
Q

What is post coital bleeding?

A

Bleeding after sexual intercourse.

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13
Q

What is dysfunctional uterine bleeding?

A

Abnormal uterine bleeding when no structural genital tract abnormality or general cause was detected.

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14
Q

What characterizes acute AUB?

A

Episodes of heavy bleeding requiring immediate intervention.

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15
Q

What characterizes chronic AUB?

A

Any form of AUB present for the majority of the preceding 6 months.

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16
Q

What is heavy menstrual bleeding?

A

Excessive menstrual blood loss which interferes with a woman’s quality of life.

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17
Q

What is intermenstrual bleeding?

A

Spontaneous bleeding occurring between menstrual periods.

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18
Q

What are the normal frequency intervals for menstruation?

A
  • Normal: 24-38 days
  • Infrequent: >38 days
  • Frequent: <24 days
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19
Q

What defines regularity in menstrual cycles?

A
  • Regular: Cycle variations within 7 days
  • Irregular: Cycle variations >8-10 days
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20
Q

What age groups are relevant for AUB?

A
  • Adolescent AUB
  • Reproductive age AUB
  • Perimenopausal AUB
  • Post menopausal AUB
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21
Q

What is the endometrium?

A

The mucosal layer lining the uterine cavity, composed of glands and specialized stroma.

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22
Q

What are the two layers of the endometrium?

A
  • Stratum functionalis
  • Stratum basalis
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23
Q

What is the myometrium?

A

The structural wall of the uterus composed primarily of smooth muscle.

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24
Q

What arteries vascularize the uterus?

Study These Flashcards
A
  • Uterine artery
  • Ovarian artery
25
What are the phases of the menstrual cycle?
* Follicular phase * Ovulation * Luteal phase
26
What happens to the corpus luteum if there is no pregnancy?
It degenerates 10 days after ovulation.
27
What occurs during the proliferative phase of the menstrual cycle?
The endometrium increases rapidly in thickness under the influence of estrogen.
28
What defines the secretory phase of the menstrual cycle?
The endometrium becomes highly vascularized under the influence of estrogen and progesterone.
29
What is the physiology of menstruation?
A balance between proliferation, decidualization, inflammation, hypoxia, apoptosis, haemostasis, vasoconstriction, and repair.
30
What is the composition of menstrual blood?
* 75% arterial blood * 25% venous blood * Endometrial tissue debris * Prostaglandins * Fibrinolysin
31
What are the general categories of causes for AUB?
* General diseases * Local pelvic causes * Contraception * Hormonal issues
32
What are polyps in relation to AUB?
Localized tumors of the columnar epithelium of the endocervix or endometrial epithelium.
33
What factors contribute to the etiology of polyps?
* Age (40-50) * DOH syndrome * Tamoxifen * HRT
34
What are common clinical features of polyps?
* Asymptomatic * Intermenstrual bleeding * Bloody discharge * Post coital bleeding * Infertility * Post menopausal bleeding
35
What investigations are used for polyps?
* Ultrasound * Saline infusion sonography * Diagnostic hysteroscopy
36
What is the management for polyps smaller than 1 cm?
Expectant management with control ultrasound.
37
What is adenomyosis?
Endometrial tissue present in the myometrium, at least 2.5mm beyond the endo-myometrial junction.
38
What is the believed cause of adenomyosis?
Endometrial basalis layer invaginates across an injured or abnormal junctional zone.
39
What tissue is present in the myometrium that is at least 2.5mm beyond the endo-myometrial junction?
Basal layer tissue ## Footnote This tissue is believed to invaginate across an injured or abnormal junctional zone.
40
What leads to adjacent hyperplasia of smooth muscle in adenomyosis?
Invagination of endometrial basalis layer ## Footnote This occurs across an injured or abnormal junctional zone.
41
What type of tumor is adenomyosis classified as?
Estrogen dependent tumor ## Footnote It has abundant expression of estrogen receptors.
42
What are the clinical features of adenomyosis?
* AUB (heavy menstrual bleeding) * Dysmenorrhea * Chronic pelvic pain * Normal speculum exam * Globular, uniformly enlarged uterus ## Footnote Rarely more than twice its normal size (12 WA), firm and tender.
43
What is the first line investigation for adenomyosis?
Ultrasound (USG) ## Footnote MRI is considered the investigation of choice.
44
What imaging features are seen on ultrasound for adenomyosis?
* Endo-myometrial border not well defined * Myometrial cysts * Globular symmetrical enlargement of uterus * Fan shaped shadowing * Translesional vascularity (Doppler) ## Footnote Posterior wall is much thicker.
45
What is the best management for adenomyosis?
Hysterectomy ## Footnote Resection of focal lesions/adenomyoma is possible for patients who desire fertility.
46
What are leiomyomas commonly called?
Uterine fibroids or myoma ## Footnote They are benign fibromuscular tumors arising from the myometrium.
47
What are the risk factors for developing leiomyomas?
* Reproductive age group * Estrogens and progesterone influence * Shrink after menopause ## Footnote Not a cause of postmenopausal bleeding.
48
What are the clinical features of leiomyomas?
* Asymptomatic (50-60%) * Heavy menstrual bleeding * Pressure effects (urine frequency, retention, constipation) * Pain from pressure effects or torsion ## Footnote Heavy menstrual bleeding occurs due to increased surface area of endometrium.
49
What is the first line diagnosis for leiomyomas?
Ultrasound ## Footnote Saline infusion sonography (SIS) is useful for mapping.
50
What is the appearance of leiomyomas on ultrasound?
Well-defined, solid, hypoechoic masses ## Footnote They cause variable acoustic shadowing and are usually round.
51
What is the management for asymptomatic leiomyomas nearing menopause?
Expectant management ## Footnote Surgical options include myomectomy and hysterectomy.
52
What is endometrial hyperplasia characterized by?
Diffuse irregular proliferation of endometrial glands ## Footnote Increased gland to stroma ratio (>50%) compared with proliferative endometrium.
53
What are the risk factors for endometrial hyperplasia?
* Chronic anovulation * Excessive ovarian cortical function * DOH syndrome * PCOS * Tamoxifen use * Estrogen producing tumors * HRT (post menopause) ## Footnote Unopposed estrogen is a key factor.
54
What are the types of endometrial hyperplasia?
* Simple hyperplasia * Complex hyperplasia (precursor of type 1 endometrial cancer) ## Footnote Complex hyperplasia shows crowded glands.
55
What are the clinical features of endometrial hyperplasia?
* Amenorrhea or infrequent bleeding * Heavy menstrual bleeding * Irregular bleeding * Normal speculum exam * Uterus normal size or slightly enlarged ## Footnote No progesterone withdrawal leads to bleeding issues.
56
What imaging technique is used to diagnose endometrial hyperplasia?
Ultrasound ## Footnote Histopathology is necessary to determine type via endometrial biopsy.
57
What is the treatment for endometrial hyperplasia without atypia?
* Levonorgestrel IUCD (5 years) * Oral continuous progesterone ## Footnote Hysterectomy is required for hyperplasia with atypia.
58
What conclusion can be drawn about abnormal uterine bleeding?
New terms are preferred to describe AUB, but old terms are still widely used ## Footnote Both structural and non-structural causes exist.

Obstetric And Gynaecology (9 decks)

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