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CMN 572 Module 4 > AUB > Flashcards

AUB Flashcards

1
Q

Menorrhagia

A

Blood loss of >80mL per cycle

FREQUENTLY PRODUCES ANEMIA

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2
Q

Metrorrhagia

A

Bleeding between periods

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3
Q

Polymenorrhea

A

Bleeding that occurs more often than every 21 days

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4
Q

Oligomenorrhea

A

Bleeding that occurs less often than every 35 days

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5
Q

Labs for AUB

A
  • CBC
  • UPT
  • Thyroid tests
  • Coagulation studies in adolescents with + heavy bleeding or adults with + screening hx
  • Vaginal or urine sample (rule out Chlamydia)
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6
Q

PALM-COEIN

A

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

C - Coagulopathy
O - Ovulatory dyscfunction
E - Endometrial
I - Iatrogenic
N - Not yet classified
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7
Q

Dx of AUB

A
  • Hx of duration and amount of flow
  • Hx of systemic infections, thyroid disease, weight change
  • Medications: warfarin, heparin, exogenous hormones
  • Herbal remedies: ginkgo, motherwort, ginseng
  • Hx of coagulation disorders
  • Complete physical exam (look for excessive weight, PCOS, thyroid disorder, insulin resistance)
  • Pelvic exam: rule out vulvar, vaginal, or cervical lesions; pregnancy; uterine myomas; adnexal masses; adenomyosis; or infection
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8
Q

Adolescents with AUB

A
  • Often occurs as a result of persistent anovulation due to immaturity of the HPO Axis and is normal physiology
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9
Q

AUB Causes

Ages 19-39

A
  • Pregnancy
  • Structural lesions
  • Anovulatory cycles
  • Use of Hormonal contraceptive
  • Endometrial hyperplasia
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10
Q

Taking a Menstrual History

- All Patients

A
  • Age of menarche
  • Cycle Length
  • Duration of bleeding
  • Perception of flow: light, medium, heavy
  • Menstrual product use
  • First day of LMP
  • Dysmennorrhea
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11
Q

Taking a Menstrual History

- Patients reporting HMB

A
  • Soaking through pad/tampon in 1h for 2-3hr in a row
  • Passing blood clots >1 inch in diameter
  • Double protection: pad and tampon or 2 pads
  • Flooding or gushing sensation
  • Frequent “accidents” or leaking through protection
  • Diagnosed with anemia in past?
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12
Q

Treatment for AUB

- Mild (<3 months and Hgb normal)

A
  • Observation
  • Keep calendar
  • Use antiprostaglandin meds (NSAIDS and Mefenamic Acid) to decrease menorrhagia
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13
Q

Treatment for AUB

- Moderate (Heavy menses, q1-3 weeks, mild anemia)

A
  • If not currently bleeding: Cyclic OCP
  • Medroxyprogesterone Acetate 10mg QD x 10 days
  • Norethindrone Acetate 5mg QD x 10 days
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14
Q

Treatment for AUB

- Severe (Prolonged/Heavy bleeding, Anemia Hgb <9)

A
  • Admit to hospital if orthosis present or Hgb <7
  • Hgb 8-10: Tapering OCPs (30mg ethinyl estradiol/0.3mg norgestrel) use q4h until bleeding stops
  • Iron supplement to improve anemia
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15
Q

Tranexamic Acid

A
  • Used to tx heavy menses for women who may desire to conceive and wish to not have their fertility negatively affected.
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16
Q

Contraindications of Tranexamic Acid

A
  • Use caution in women with a personal hx of thromboembolism
17
Q

Mefenamic Acid SE

A
  • GI Effects
  • Not suitable for women who have previously had PUD or who are thought to have HMB d/t coagulation disorder
  • If beneficial, may be continued indefinitely
18
Q

NSAIDS in Management of AUB

A
  • Limitation of inflammatory mediators is helpful to treat AUB
19
Q

Hormonal Tx of AUB

A
  • Maintenance of progesterone exposure limits endometrial inflammation and prevents menstruation
  • These are the MOST EFFECTIVE txs available for HMB
20
Q

Injectable Progesterone

A
  • Offers women alternative to pills or IUD
  • Excellent for women who experience frequent or irregular HMB
  • CAUTION: slight reduction in bone mineral density with long-term use
21
Q

GnRH Agonist

Delivery system and Dose

A
  • IM, SQ, Intranasal

- 5mg TID from day 5-26 of menstrual cycle

22
Q

GnRH Agonist

MOA

A
  • Decreases LH/FSH -> Hypogonadal State -> MEDICAL MENOPAUSE

- Reduces amenorrhea rate of up to 90%

23
Q

GnRH Agonist

Uses

A
  • Tx of uterine fibroids (leiomyoma) -> reduce size when hormone level suppressed
24
Q

GnRH Agonist

SE

A
  • Flushing
  • Vaginal Dryness
  • HA
  • Decreased libido
25
Q

Oral Progesterone

Most Common

A
  • Norethisterone
26
Q

Oral Progesterone

Dose

A
  • 5mg tablet TID from day 5-26 of menstrual cycle
27
Q

Levonorgestrel-releasing Intrauterine System

MOA

A
  • IUD

- decreases menstrual loss by up to 96% after 1 year of use; tx of HMB for 5 years -> remove and replace with new device

28
Q

Levonorgestrel-releasing Intrauterine System

Pros

A
  • Does not require patient compliance

- Reduction of dysmenorrhea

29
Q

Levonorgestrel-releasing Intrauterine System

Potential Complications

A
  • Unscheduled bleeding: most common during first 3-6 months of use
  • Infection: increased risk first 3 weeks after insertion; DO NOT USE TAMPONS
  • Expulsion of IUD: highest risk during first 6 weeks after insertion; higher in nulliparous women
  • Perforation: rare, occurs 1:1000 cases
30
Q 
SPRMs
Ulipristal Acetate (UPA)
A
  • Restricted to 3 months pretreatment of fibroids prior to surgical intervention
  • Effective in treating HMB associated with uterine fibroids (3-10cm in size)
  • Control of HMB achieved significantly quicker than with GnRH Agonist
  • SE limited to HA and breast complaints
  • No publications currently about clinical utility of SPRM in women who do not have fibroids
31
Q

COCs

Estrogen and Progestogen

A
  • On 3 weeks, Off 1 week
32
Q

COCs

Pros

A
  • Excellent for women experiencing frequent or irregular HMB
  • Produces estimated reduction of blood loss of 50%
  • Regulation of bleeding
33
Q

COCs

Contraindications

A
  • Women with BMI >35
  • Smokers over 35 yo
  • HTN
  • Vascular disease
  • Migraines with aura
  • Current/Recent breast cancer
  • Personal or strong fam hx of venous thromboembolism
34
Q

Progesterone Only Pill

A
  • Not recommended for HMB treatment

CMN 572 Module 4 (3 decks)

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