Abnormal Uterine Bleeding

Question 1

what is defined as uterine bleeding occurring at regular intervals of less than 21 days?

Answer 1

polymenorrhea

Question 2

what is defined as prolonged (greater than 7 days) or excessive (greater than 80mL) uterine bleeding occurring at regular intervals?

Answer 2

menorrhagia

Question 3

what is defined as uterine bleeding occurring at intervals greater than 35 days?

Answer 3

oligomenorrhea

Question 4

what is defined as bleeding that occurs at frequent, but irregular intervals?

Answer 4

metrorrhagia

Question 5

what is defined as uterine bleeding that is prolonged or excessive but also frequent and irregular ?

Answer 5

menometrorrhagia

Question 6

how much blood loss is necessary to define menorrhagia?

Answer 6

greater than 80 mL

Question 7

what are the two main mechanisms for hemostasis during menstruation?

Answer 7

formation of hemostatic plug; vasoconstriction

Question 8

a pt with postcoital bleeding should be worked up for which two differentials?

Answer 8

cervical cancer and cervicitis

Question 9

what 4 tests should be ordered as part of the workup for abnormal uterine bleeding?

Answer 9

FSH, TSH, PRL, and beta hCG

Question 10

what is the time frame for a normal menstrual cycle?

Answer 10

every 21 to 35 days w/ menstruation lasting 2 to 7 days

Question 11

what are the most common types of cancer associated with reproductive age bleeding?

Answer 11

cervical and endometrial

Question 12

what is the most common cause of hospital admission for menorrhagia in adolescents?

Answer 12

von Willebrand disease

Question 13

t or f: hyperthyroidism causes an ovulation and is frequently associated with menorrhagia and intermenstrual bleeding

Answer 13

FALSE - hyPO

Question 14

t or f: cirrhosis can be a cause of excessive bleeding during menstruation

Answer 14

TRUE - secondary to reduced capacity of the liver to metabolize estrogens

Question 15

t or f: abnormal uterine bleeding is a diagnosis of exclusion

Answer 15

TRUE

Question 16

how is the diagnosis of ovulatory abnormal uterine bleeding made?

Answer 16

endometrial biospy

Question 17

what is the relationship between estrogen and the endometrium? progesterone?

Answer 17

estrogen stimulation leads to constant endometrial proliferation; progesterone is what mediates maturation and shedding

Question 18

what is the treatment of choice for pts with heavy bleeding and hemodynamic instability?

Answer 18

d&c; note: once bleeding is controlled, pt can be placed on medical management

Question 19

t or f: medical management is the first line treatment for pts with abnormal uterine bleeding.

Answer 19

true

Question 20

what is the mainstay of treatment for anovulatory bleeding?

Answer 20

OCP

Question 21

what is the mcc of post menopausal bleeding?

Answer 21

atrophy (vaginal/endometrial)

Question 22

how is post menopausal bleeding defined?

Answer 22

bleeding that occurs after 1 year of amenorrhea

Question 23

what is the most common lethal cause of post menopausal bleeding?

Answer 23

endometrial cancer

Question 24

t or f: HRT for menopausal women with a uterus must contain estrogen only pills

Answer 24

FALSE: must contain progestin ALONG with estrogen to prevent endometrial hyperplasia/carcinoma

Question 25

what is the MOA behind vaginal/endometrial atrophy?

Answer 25

in the uterus, the collapsed endometrial surface contains little or no fluid to prevent intrauterine cavitary friction resulting in micro erosions leading to bleeding

Question 26

why is it that obese women have higher levels of endogenous estrogen?

Answer 26

b/c of the conversion of androstenedione to estrone and the aromatization of androgens to estradiol, both of which occur in peripheral adipose

Question 27

vaginal bleeding plus foul smelling discharge in a post menopausal female is diagnostic of what?

Answer 27

cervical cancer

Question 28

what are the top 4 ddx for thickened endometrial stripe in a post menopausal woman? (stripe is seen of TVUS)

Answer 28

endometrial ca, endometrial hyperplasia, leiomyoma and polyps

Question 29

what is the MOA behind cervical cancer causing bleeding?

Answer 29

the cancer has outgrown its blood supply

Question 30

when should uterine sarcoma be considered part of the differential for post menopause women?

Answer 30

when there's are rapidly growing leiomyomata

Question 31

physical exam, it reveals dry pale vaginal mucosa with lost rugae - what is the diagnosis?

Answer 31

vaginal atrophy

Question 32

how is vaginal atrophy treated?

Answer 32

topical estrogen cream

Question 33

how is endometrial hyperplasia with atypia treated?

Answer 33

as CA as this indicates underlying CA typically; hysterectomy is treatment of choice

Question 34

what is the treatment for endometrial hyperplasia without atypia?

Answer 34

progestin and ongoining monitoring