Abnormal Uterine Bleeding - Schoyer Flashcards Preview

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Flashcards in Abnormal Uterine Bleeding - Schoyer Deck (23):
1

Define polymenorrhea

frequent menstruation with bleeding intervals shorter than 21 days

2

Define menorrhagia

excessive menstrual bleeding (flow >80mL and/or duration >7 days)

3

Define metrorrhagia

irregular menstrution intervals

4

Define menometrorrhagia

irregular menstruation intervals with excessive flow and/or duration

5

Define oligomenorrhea

menstruation fewer than 9 times per year (average bleeding intervals >35 days

6

Define hypomenorrhea

Very light or short-duration menstruation

7

What is intermenstrual bleeding?

Uterine bleeding in between apparently normal ovulatory menses

8

What is a uterine fibroid?

What symptoms are associated with uterine fibroids?

Uterine leiomyoma - a benign neoplasm of the uterus

Symptoms depend on exact location of the fibroid(s), but may include:

  • Menorrhagia/menometrorrhagia with refractory anemia
  • Intermenstrual dysmenorrhea
  • Mass symptoms (urinary pressure/urgency, constipation, flank pain, increasing abdominal girth

9

At what age do uterine fibroids typically present?

Are they hormonally responsive?

 

Most prevalent during reproductive years. They rarely present during puberty and often regress after onset of menopause

Yes, they are hormonally responsive -> Leiomyomas have increased amounts of both estogen and progesterone receptor mRNA

10

Name (3) benign neoplasms of the uterus

Endometrial polyps

Endocervial polyps

Adenomyosis

11

In what layer of the uterus are endometrial polyps found?

Endocervical polyps?

Adenomyosis?

As fleshy outgrowths of the endometrium

As outgrowths of cervical mucosa

As a benign invasion of the endometrium into the myometrium

12

Anovulation and abnormal uterine bleeding are most common at what ages?

What usually drives formation of these symptoms? What happens structurally to the uterus?

Discuss the relevance of this process to neoplasms of the uterus

Common at the extremes of reproductive age

Often due to chronic exposure of the endometrium to estrogen without cyclic exposure to postovulatory progesterone. This causes the endometrium to become abnormally thickened and structurally incompetent. Asynchronous shedding occurs without progesterone-driven vasoconstriction, often leading to heavy bleeding.

Abnormal cycling predisposes patients to endometrial hyperplasia and endometrial cancer. Increased risk is proportional to the duration of unoppose estrogen exposure.

13

Name two major types of uterine malignant neoplasms

Endometrial cancer

Cervical cancer

14

How is endometrial cancer usually diagnosed?

Endometrial biopsy or endometrial curettage/hysteroscopy specimens

15

'Spotting' is often related to what?

Maybe it doesn't seem like a big deal -> why is it actually a big deal?

Endometrial atrophy related to hypoestrogenism

Endometrial atrophy with spotting is clinically indistinguishable from the earliest symptoms of endometrial cancer and therefore requires extensive workup and careful evaluation to rule out cancer. This is especially true in peri-/post-menopausal women.

16

What imaging options are indicated for evaluation of abnormal uterine bleeding and anovulation?

  • Pelvic ultrasound
  • Hysterosonogram
  • Pelvic MRI
  • Hysteroscopy

17

What medical/hormonal management strategies might be employed to minimize fibroid bleeding issues?

Oral contraceptive pills

GnRH agonists or antagonists

Progesterone receptor modulators

Aromatase inhibitors

18

What surgical treatment options exist for endometrial polyps and uterine fibroids?

Endometrial polyps: operative hysteroscopy

Uterine fibroids: myomectomy via abdominal, laparoscopic, or hysteroscopic routes

Other options might include: uterine artery embolization (interventional radiology) or MRI-guided focused ultrasound surgery (this is incredibly cool)

19

What is endometriosis?

The presence of endometrial glands and stroma ourside the endometrial cavity and uterine musculature, often resulting in adhesions, pain, infertility, and a generalized inflammatory state.

20

What is a "chocolate cyst"?

An endometrial cyst related to endometriosis

Often occurs due to sloughed endometrium that migrates to the ovary and grows slowly over time due to accumulated blood (hence the brown/chocolate color).

21

Describe the treatment approach and rationale for each in endometriosis

Why do these treatments make addressing infertility issues especially difficult?

Hormonal suppression (oral contraceptives, GnRH agonists, aromatase inhibitors) to minimize stimulation of endometriosis tissue

NSAIDs to decrease prostaglandin-driven inflammation

Infertility challenges:

  • Hormonal suppression therapy also suppresses ovulation
  • May result in severe adhesions that are hard to correct surgically
  • Higher risk of ectopic pregnancy

22

Give (4) reasons endometriosis contributes to infertility

  • Adhesions distort normal pelvic anatomy
  • Ovarian cysts
  • Macrophages and cytokines create inflammatory state in the pelvis
  • Alters endometrial receptivity (negatively)

23

What should you never forget to test for in evaluating abnormal bleeding and/or anovulation?

pregnancy test

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