Abnormal Uterine Bleeding Flashcards
what is defined as uterine bleeding occurring at regular intervals of less than 21 days?
polymenorrhea
what is defined as prolonged (greater than 7 days) or excessive (greater than 80mL) uterine bleeding occurring at regular intervals?
menorrhagia
what is defined as uterine bleeding occurring at intervals greater than 35 days?
oligomenorrhea
what is defined as bleeding that occurs at frequent, but irregular intervals?
metrorrhagia
what is defined as uterine bleeding that is prolonged or excessive but also frequent and irregular ?
menometrorrhagia
how much blood loss is necessary to define menorrhagia?
greater than 80 mL
what are the two main mechanisms for hemostasis during menstruation?
formation of hemostatic plug; vasoconstriction
a pt with postcoital bleeding should be worked up for which two differentials?
cervical cancer and cervicitis
what 4 tests should be ordered as part of the workup for abnormal uterine bleeding?
FSH, TSH, PRL, and beta hCG
what is the time frame for a normal menstrual cycle?
every 21 to 35 days w/ menstruation lasting 2 to 7 days
what are the most common types of cancer associated with reproductive age bleeding?
cervical and endometrial
what is the most common cause of hospital admission for menorrhagia in adolescents?
von Willebrand disease
t or f: hyperthyroidism causes an ovulation and is frequently associated with menorrhagia and intermenstrual bleeding
FALSE - hyPO
t or f: cirrhosis can be a cause of excessive bleeding during menstruation
TRUE - secondary to reduced capacity of the liver to metabolize estrogens
t or f: abnormal uterine bleeding is a diagnosis of exclusion
TRUE
how is the diagnosis of ovulatory abnormal uterine bleeding made?
endometrial biospy
what is the relationship between estrogen and the endometrium? progesterone?
estrogen stimulation leads to constant endometrial proliferation; progesterone is what mediates maturation and shedding
what is the treatment of choice for pts with heavy bleeding and hemodynamic instability?
d&c; note: once bleeding is controlled, pt can be placed on medical management
t or f: medical management is the first line treatment for pts with abnormal uterine bleeding.
true
what is the mainstay of treatment for anovulatory bleeding?
OCP
what is the mcc of post menopausal bleeding?
atrophy (vaginal/endometrial)
how is post menopausal bleeding defined?
bleeding that occurs after 1 year of amenorrhea
what is the most common lethal cause of post menopausal bleeding?
endometrial cancer
t or f: HRT for menopausal women with a uterus must contain estrogen only pills
FALSE: must contain progestin ALONG with estrogen to prevent endometrial hyperplasia/carcinoma
what is the MOA behind vaginal/endometrial atrophy?
in the uterus, the collapsed endometrial surface contains little or no fluid to prevent intrauterine cavitary friction resulting in micro erosions leading to bleeding
why is it that obese women have higher levels of endogenous estrogen?
b/c of the conversion of androstenedione to estrone and the aromatization of androgens to estradiol, both of which occur in peripheral adipose
vaginal bleeding plus foul smelling discharge in a post menopausal female is diagnostic of what?
cervical cancer
what are the top 4 ddx for thickened endometrial stripe in a post menopausal woman? (stripe is seen of TVUS)
endometrial ca, endometrial hyperplasia, leiomyoma and polyps
what is the MOA behind cervical cancer causing bleeding?
the cancer has outgrown its blood supply
when should uterine sarcoma be considered part of the differential for post menopause women?
when there’s are rapidly growing leiomyomata
physical exam, it reveals dry pale vaginal mucosa with lost rugae - what is the diagnosis?
vaginal atrophy
how is vaginal atrophy treated?
topical estrogen cream
how is endometrial hyperplasia with atypia treated?
as CA as this indicates underlying CA typically; hysterectomy is treatment of choice
what is the treatment for endometrial hyperplasia without atypia?
progestin and ongoining monitoring
