Abnormal Uterine Bleeding (AUB)

Question 1

What is Abnormal Uterine Bleeding (AUB)?

Answer 1

Menstrual bleeding of abnormal quantity, duration of schedule

Question 2

What is the acronym for the AUB etiologies?

Answer 2

PALM-COEIN

Question 3

What does PALM-COEIN stand for?

Answer 3

Polyp
Adenomyosis
Leiomyoma
Malignancy/Hyperplasia
Coagulopathy
Ovulatory Dysfunction
Endometrial
Iatrogenic: anticoagulants, OCP, IUD, infection/inflammation
Not yet classified

Question 4

What is postcoital bleeding until proven otherwise?

Answer 4

Cervical Cancer

Question 5

What are the routine diagnostic tests with AUB?

Answer 5

CBC: check Hgb and Hct
PT/PTT: evaluate coagulation disorders
Pelvic US: anatomical abnormality

Question 6

What is an endometrial biopsy indicated for AUB?

Answer 6

Any postmenopausal bleed
AUB in F>45
F<45 with BMI>30: chronic unopposed estrogen, failed medical management or high risk of endometrial cancer
Atypical glandular or endometrial cells on pap smear

Question 7

What occurs in an anovulotory cycle?

Answer 7

Ovary produdes estrogen but no CL is formed: progesterone is not produced which prevents withdrawal bleeding

Continuously high estrogen stimulates growth of the endometrium: bleeding will occur once endometrium outgrows the blood supply

Question 8

How do you treat Ovulatory Dysfunction?

Answer 8

Long-acting reversible contraception: Best initial therapy
-Levonorgestrel IUD is preferred

D&C for acute hemorrhage to stop the bleeding

Question 9

When is AUB regarded as severe?

Answer 9

Pt is anemic, bleeding is uncontrolled with medical management or pt reports a compromised lifestyle

Question 10

How do you treat severe AUB?

Answer 10

endometrial ablation or hysterectomy

Question 11

What is postmenopausal bleeding considered until proven otherwise?

Answer 11

Endometrial Cancer

Question 12

What is the best initial test for postmenopausal bleeding?

Answer 12

Endometrial biopsy