Abnormal Uterine Bleeding 2

Question 1

What percentage of abnormal uterine bleeding cases due to ovulatory dysfunction occur in women over 45 years old?

Answer 1

• Ovulatory dysfunction occurs most often in women >45 years old, accounting for >50% of cases.

Question 2

What percentage of abnormal uterine bleeding cases due to ovulatory dysfunction occur in adolescents?

Answer 2

20 %

Question 3

What term was formerly used to describe non-structural causes of abnormal uterine bleeding?

Answer 3

dysfunctional uterine bleeding

Question 4

What age group is most commonly associated with ovulatory dysfunction in abnormal uterine bleeding, aside from adolescents?

Answer 4

Women over 45 years old are indeed commonly associated with ovulatory dysfunction.

Question 5

What is the nature of the causes of abnormal uterine bleeding that are more difficult to diagnose, according to the provided information?

Answer 5

Non structural causes

Question 6

Definition of abnormal uterine bleeding

Answer 6

Bleeding not in alignment with normal uterine cycle parameters (duration , frequency, volume)

Question 7

What population specifically experiences AUB as a common problem?

Answer 7

Reproductive age women

Question 8

What does PALM ( structural) in the PALM-COEIN classification of Abnormal Uterine Bleeding (AUB) stand for?

Answer 8

PALM stands for:

P - Polyp
A - Adenomyosis
L - Leiomyoma
M - Malignancy and hyperplasia

Question 9

What does COEIN stand for?

Answer 9

COEIN stands for:

C - Coagulopathy
O - Ovulatory dysfunction
E - Endometrial dysfunction
I - Iatrogenic
N - Not yet classified

Well done!

Question 10

What is the most common inherited cause of coagulopathy in AUB?

Answer 10

Von Williband disease

Question 11

What medication is used to manage bleeding in Von Willebrand disease?

Answer 11

1) Desmopressin (a vasopressin analogue)
2) plasma-derived factor VIII or recombinant factor rVWF,
3) Tranexamic acid are used.

Question 12

What is the most common acquired cause of coagulopathy mentioned?

Answer 12

Immune thrombocytopenic purpura (ITP)

Question 13

At what life stage is coagulopathy typically seen?

Answer 13

Coagulopathy due to systemic disorders of hemostasis is typically seen in:
Inherited
Adolescence for some cases,

Acquired
while Immune thrombocytopenic purpura is seen in adulthood.

Question 14

What symptom is commonly associated with coagulopathy apart from heavy menstrual bleeding?

Answer 14

Some common symptoms associated with coagulopathy apart from heavy menstrual bleeding include:

• Bleeding associated with other procedures (dental work, surgery, PPH)
• Easy Bruising
• Gum bleeding
• Epistaxis
• Family history of abnormal bleeding

Question 15

What is the role of VWF in hemostasis?

Answer 15

VWF:

• Maintains Factor VIII in circulation necessary for the intrinsic pathway
• Helps platelet adhesion and aggregation

Question 16

What type of factor is Desmopressin?

Answer 16

Desmopressin is indeed a:

Vasopressin analogue

used in managing bleeding disorders.

Question 17

What does VWF stand for?

Answer 17

VWF stands for:

Von Willebrand Factor

Question 18

In what type of cases is heavy menstrual bleeding seen from menarche in coagulopathy?

Answer 18

Heavy menstrual bleeding from menarche is more characteristic of:

Inherited causes of coagulopathy.

Question 19

What does FIGO stand for in the context of AUB classification?

Answer 19

FIGO stands for:

International Federation of Gynecology and Obstetrics

Question 20

What is the most common cause of ovulatory dysfunction (AUB-O)?

Answer 20

PCOS (Polycystic Ovary Syndrome) is indeed the most common cause of ovulatory dysfunction (AUB-O).

Question 21

What happens to the endometrium in the absence of ovulation and progesterone production?

Answer 21

In the absence of ovulation and progesterone production:

The endometrium continues to grow due to estrogen, and eventually:

• Runs out of vascular supply
• Leads to breakthrough bleeding

Question 22

What are the two medications mentioned for managing hyperprolactinemia?

Answer 22

1. Cabergoline
2. Bromocriptine

Question 23

What type of bleeding is associated with ovulatory dysfunction, according to the text?

Answer 23

Breakthrough bleeding

it’s due to:

• Estrogen-driven endometrial growth
• Inability of blood supply to vascularize thick endometrium

Question 24

What are the general measures mentioned for managing ovulatory dysfunction?

Answer 24

1. Weight loss
2. Reduce extreme exercise
3. Counselling on feeding

Question 25

What is used to manage heavy bleeding in ovulatory dysfunction?

Answer 25

1. Progesterone 2. Tranexamic acid Well done!

Question 26

What is a potential consequence of prolonged anovulation?

Answer 26

Prolonged anovulation can lead to: Hyperplasia Which can potentially progress to: Atypia

Question 27

What type of women might receive expectant management for ovulatory dysfunction?

Answer 27

1. Adolescents 2. Perimenopausal women

Question 28

What is one of the characteristics of menstrual bleeding in women with ovulatory dysfunction?

Answer 28

menstrual bleeding in women with ovulatory dysfunction can be characterized by: - Unpredictable timing - Variable amount of flow Which can sometimes manifest as: - Heavy menstrual bleeding - Extremely light or infrequent bleeding

Question 29

What is potential underlying cause of ovulatory dysfunction mentioned in the text?

Answer 29

oPCOS (most common) o Hyperprolactinemia o Hypothyroidism oMental stress o Obesity o Anorexia oWeight loss or extreme exercise • Rule out hyperplasia/malignancy

Question 30

What might be a consequence that needs to be ruled out in cases of ovulatory dysfunction?

Answer 30

In cases of ovulatory dysfunction, it's important to rule out: 1. Hyperplasia 2. Malignancy

Question 31

What type of bleeding pattern is associated with long cycles in ovulatory dysfunction?

Answer 31

In ovulatory dysfunction: - Long cycles can be followed by - Heavy menstrual bleeding

Question 32

What are the two management options mentioned for endometrial causes of AUB-E?

Answer 32

1. NSAIDs 2. Tranexamic acid

Question 33

What is the characteristic of menstrual bleeding in cases of endometrial causes of AUB-E?

Answer 33

In endometrial causes of AUB-E: - Heavy menstrual bleeding occurs - With predictable and cyclic menstrual bleeding, typical of ovulatory cycles

Question 34

What are some possible factors contributing to primary disorder of the endometrium in AUB-E?

Answer 34

1. Impaired vasoconstriction 2. Enhanced fibrinolysis 3. Increased local production of vasodilators 4. Genetic factors 5. Disorders secondary to endometrial inflammation or infection (like chlamydia) Well done!

Question 35

Is endometrial cause of AUB-E a diagnosis of exclusion?

Answer 35

A diagnosis of exclusion Because AUB -E defined as "Heavy menstrual bleeding in absence of any definable cause with predictable and cyclic menstrual bleeding, typical of ovulatory cycles"

Question 36

What is the nature of menstrual bleeding in terms of cycle predictability in cases of endometrial causes of AUB-E?

Answer 36

"Heavy menstrual bleeding... with predictable and cyclic menstrual bleeding, typical of ovulatory cycles" So, the bleeding follows a predictable pattern, in line with the menstrual cycle.

Question 37

What are some examples of drugs/procedures that can cause iatrogenic AUB-I due to inhibition of ovulation, specifically through hyperprolactinemia?

Answer 37

Drugs that cause hyperprolactinemia. 1. Antipsychotics 2. Antidepressants (e.g., amitriptyline) 3. Prokinetic drugs (e.g., metoclopramide, domperidone) 4. Anticonvulsants (e.g., phenytoin) 5. Antihypertensives (e.g., methyl dopa, labetalol) 6. Others (e.g., cimetidine, ranitidine, alcohol)

Question 38

What are the management options mentioned for iatrogenic AUB-I?

Answer 38

The management options mentioned for iatrogenic AUB-I are: 1. NSAIDs 2. Tranexamic acid 3. Treat the cause Well done!

Question 39

What type of contraceptive method is associated with breakthrough bleeding as a cause of AUB-I?

Answer 39

combined oral contraceptive pills are associated with: Breakthrough bleeding COC pills also a cause of AUB-I.

Question 40

What is another contraceptive method mentioned as a cause of AUB-I, particularly notable for bleeding in the first 3 months?

Answer 40

According to the text, Cu IUCD (Copper Intrauterine Contraceptive Device) is associated with AUB-I, particularly notable for bleeding in the: First 3 months

Question 41

What class of medications is mentioned as a cause of AUB-I?

Answer 41

oAnticoagulants

Question 42

What type of surgical procedures are associated with AUB-I?

Answer 42

post-gynecologic surgery

Question 43

What type of contraceptive is mentioned as a cause of AUB-I, specifically progesterone-based?

Answer 43

1. Depo Provera 2. Levonorgestrel implants Both are progesterone-based contraceptives.

Question 44

What is the potentially life-threatening condition mentioned in the text that involves abnormal connections between arterial and venous circulation in the uterus?

Answer 44

That's correct! Uterine arteriovenous malformations (AVM) are indeed mentioned as a rare cause of AUB-N, characterized by abnormal connections between arterial and venous circulation in the uterus, and can be potentially life-threatening due to profuse bleeding.

Question 45

What is the typical method used to confirm the diagnosis of uterine AVM?

Answer 45

Colour Doppler or angiography is used to confirm the diagnosis of uterine arteriovenous malformations (AVM).

Question 46

What is the term "isthmiocele" referring to in the context of AUB-N?

Answer 46

Isthmiocele refers to defective healing or scarring after surgical opening of the uterus, typically after a cesarean section.

Question 47

What is the most effective treatment method for isthmocele mentioned in the text?

Answer 47

A surgical hysteroscopy is the most effective treatment method.

Question 48

What is the criteria mentioned in the text for designating a uterus as having myometrial hypertrophy?

Answer 48

symmetrically enlarged uteri weighing 120 grams or more in which no pathologic changes other than increased size can be demonstrated.

Question 49

Management of Uterine arteriovenous malformations (AVM)

Answer 49

1) Emboslisation 2) resection of affected area, 3) hysterectomy

Question 50

What symptom is sometimes associated with myometrial hypertrophy, according to the text?

Answer 50

heavy menstrual bleeding

Question 51

Not otherwise classified causes (AUB)

Answer 51

oArteriovenous malformations oCervical niche or ‘isthmiocele’ o Endometriosis oMyometrial hypertrophy

Question 52

What is the main cause of ovulatory dysfunction in adolescent AUB, according to the text?

Answer 52

the main cause of ovulatory dysfunction in adolescent AUB is indeed an immature HPO (hypothalamic-pituitary-ovarian) axis, leading to anovulatory cycles.

Question 53

What is another potential cause of AUB mentioned in the text for adolescents, aside from ovulatory dysfunction?

Answer 53

Coagulopathies

Question 54

What is the first step in evaluating AUB in the reproductive age group, according to the text?

Answer 54

Rule out pregnancy and related events (abortion, ectopic pregnancy)

Question 55

What are the potential causes of AUB mentioned in the text for the perimenopausal age group?

Answer 55

1. Depletion of ovarian reserve (leading to ovulatory dysfunction) 2. Malignancy and hyperplasia 3. Other structural causes

Question 56

In the reproductive age group: What are the potential causes of AUB mentioned in the text? (Hint: It's an acronym)

Answer 56

The PALM COEIN acronym represents the potential causes of AUB in the reproductive age group: P - Polyp A - Adenomyosis L - Leiomyoma M - Malignancy and hyperplasia C - Coagulopathy O - Ovulatory disorders E - Endometrial I - Iatrogenic N - Not yet classified You're doing great!