AUB differential diagnosis

Question 1

Characteristics of ovulatory AUB

Answer 1

ovulatory bleeding is characterized by:

• regular menstrual cycles
• menstrual cramping/PMS
• Secretory endometrium on a biopsy

Question 2

Characteristics of anovulatory AUB

Answer 2

anovulatory AUB is characterized by:

• irregular cycles
• history of infertility, obesity, PCOS
• no evidence of secretory endometrium on biopsy

Question 3

Submucosal fibroids
Type 0
Type I
Type II

Answer 3

Submucosal Fibroids
Type 0- pedunculated in the endometrial cavity
Type I- >50% in endometrial cavity
Type II- <50% in endometrial cavity

Question 4

most common causes for AUB

• reproductive age
• perimenopausal
• postmenopausal

Answer 4

Reproductive age: exogenous, pregnancy (problems with pregnancy: miscarriage/retained tissue, ectopic pregnancy, trophoblastic disease), anovulation

Perimenopausal: Anovulation, fibroids, cervical and endometrial polyps

Postmenopausal: Atrophy, endometrial polyps, endometrial cancer

Question 5

Important elements in the HISTORY

Associated symptoms

Answer 5

History:
-Onset (gradual vs sudden), perimenarche, , perimenopause, temporal (postcoital, postpill, post partum)
-Characteristics
-is she ovulating
Associated symptoms: weight gain, fatigue, N/V, fever
endocrinopathy

Question 6

Treatment:
1st line meds:

2nd line meds:

Answer 6

1st line medications: NSAIDS and contraceptives (progestin only, COCP, levonorgestrol IUD)

2nd line meds: antifibrinolytics, GnRH agonists, androgens

Question 7

Medical Management of Acute Uterine Bleeding

Unstable pt:

Stable pt:

Answer 7

If the pt. is hemodynamically unstable your first priority is to stabilize

• Large bore IV placement (IV fluids)
• CBC/type and cross
• intensive monitoring
• STOP BLEEDING: dilation and curettage

Stable pt.

• estrogen (promotes clotting)
• progestins
• surgical options