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Reproductive Exam 2 > AUB & DUB > Flashcards

AUB & DUB Flashcards

(56 cards)

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1
Q

what is abnormal uterine bleeding (AUB)

A

any pattern of bleeding other than reg. ovulatory cycles

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2
Q

what is dysfunctional uterine bleeding (DUB)

A

AUB that CANNOT be attributed to medications, blood dyscrasias, systemic diseases, trauma, infection, uterine neoplasms, preg

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3
Q

what is the effect of estrogen on the endometrium

A

growth, proliferation

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4
Q

what happens after the LH surge

A

ovulation and the CL forms

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5
Q

what is happening in the secretory endometrium

A

the CL produces estrogen and progestrone

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6
Q

If no CL, what happens to E and P

A

its drops –> synchornized sloughing of the endometrium (aka period), mostly d/t the drop in progesterone

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7
Q

what limits the bleeding

A

prostaglandins –> increasing levels creates endometrial ischemia

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8
Q

what happens to E and P in anovulatory cycle

A

no progesterone rise BUT estrogen is normal ( i think)

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9
Q

without progesterone what happens to the lining

A

it keeps proliferating, thus having sporadic bleeding, no ovulation, partial sloughing of endometrium

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10
Q

why do you bleed then in anovulatory cycle

A

bleeding is caused by the inability of estrogen - that needs to be present to stimulate the endometrium in the first place - to support a growing endometrium

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11
Q

is the bleed heavy or light, and why

A

heavy, bc there are lower levels of prostaglandins –> less vasoconstriction

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12
Q

what happens in repeated anovulatory cycles

A

increased likelihood of:

  1. excessive blood loss
  2. endometrial hyperplasia
  3. endometrial carcinoma
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13
Q

Menorrhagia

A

Excessive or prolonged menses at normal interval - >80cc or 7 days

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14
Q

polymenorrhagia

A

more frequent menses

interval <21 days cycle

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15
Q

metrorrhagia

A

irregular menses

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16
Q

Menometrorrhagia/Metromenorrhagia

A

heavy, irregular menses

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17
Q

oligo-amenorrhea

A

> 35 day interval over a 6 month period

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18
Q

amenorrhea

A

no menses for 3 months

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19
Q

causes of AUB

A

medications, blood dyscrasias, systemic diseases, trauma, infection, uterine neoplasms

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20
Q

break-through bleeding

A

a SE of BCP that shoudl go away by 3rd month; can be controlled by changing the type of COCP

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21
Q

BCP

A

all BCP has teh same estrogen (EE) but at different doses, the only thing thats differs btwn pills is the progestin
-goal of COCP is to control birth and cycle

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22
Q

Depo-provera

A

IM injection of pure progesterone (every 3 months)

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23
Q

what happens with constant progesterone

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A

causes the lining to thin out (thus won’t bleed)

24
Q

SE of depo-provera and why its a cuase of AUB

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A

eventually can lead to all bleeding patterns

25
IUD
- can cause menorrhagia - you got something foreign up there, it can bleed - ones with progesterone in it can cause lighter, shorter bleeding
26
what blood dyscrasias mentioned in class can cause AUB
Von Willebrand's Disease
27
systemic diseases of liver, renal and what else
Thyroid - most common - hypothyroidism --> won't have ovulatory cycles - so fix this and you'll fix AUB
28
what infections can cause AUB
- cervicitis - endomyometritis - PID
29
types of benign neoplasms that can cuase AUB
1. endocervical polyps - post-sex bleeding 2. endometrial polyps 3. leiomyomas 4. adenomyosis 5. endmetrial hyperplasia
30
malignany neoplasms that can cause AUB
1. cervical carcinoma | 2. uterine carcinoma
31
if pts is post-meno and bleeding
think cancer
32
DUB most commonly occurs in what age group
``` just menstruating (11-14) premenopausal ```
33
what is DUB almost always caused by
aberrations of the hypothalamic-pit-ovarian axis --> anovulation
34
FIGO classification of AUB
PALM-COEIN | -sidenote: PALM- are more structural parts
35
AUB-P
polyps (endometrial or cervical)
36
AUB- A
Adenomyosis
37
AUB - L
leiomyomata
38
AUB- M
Malignancy or pre-malig - endometrial carcinoma - endometrial hyperplasia
39
AUB -C
Coagulopathy | -VW's , anti-coagulants
40
AUB-O
(An)Ovulatory
41
AUB-E
endometrial | - combo of asymptomatic polyps, adenomyosis, leiomyomata
42
AUB - I
Iatrogenic (hormonal pills) - gonadal steriods - -E and P, androgens - gonadal-related therapy - -GnRH agonists, SERM, progesterone receptor modulators
43
AUB -N
not classified
44
what is wrong with the endometrium in DUB (>35 yrs better becareful)
usually prolifertaive or discordant endometrium | -result of 'unoppsed estrogen'
45
what is DUB associated with
PCOS, anovulatory or oligo-anovulatory cycles
46
whats the first thing you need to do for DUB work up
R/O preggers !! | and later malignancy
47
DUB physical exam
make sure its the uterine | r/o truama, infection, neoplasms
48
DUB pelvic u/s
endometrial thickness (<4 in you good- postmeno) polyps fibroids
49
DUB labs
CBC, serum Fe and TIBC, hCG, TFT, LFT, prolactin, serum progest in Luteal phase, FSH
50
DUB tissue eval
pap smear, endometrial biopsy, hysteroscopy, D&C
51
how do you treat moderate DUB
BCP - used for more predictable, shorter, lighter, less painful bleeding cyclic E and P cyclic P - for DVT and >35 yrs
52
Cyclic E and P plan
- Conjugated estrogen 1.25mg or micronized estradiol 2mg for 25 days - Medroxy-progesterone acetate 10mg or Megace 5mg days 16-25 - Drug-free for the rest of the month
53
cyclic P plan
- Medroxy-progesterone acetate 10mg, Norethindrone 5mg or Megace 5mg for 10 days each month - Counting on their own estrogen making
54
how do you treat severe DUB
- IV Conjugated estrogens 25mg every four hours until it subsides for 24 hours. - -Can stop any bleeding with this - -And then change them onto oral regimen and follow up - Change to Conjugated estrogen 1.25mg or 2mg of micronized estradiol PO every 4-6 hours for 24 hours. - Taper to the same dose PO daily for 7-10 days. - Follow with progesterone for 10 days.
55
what do you do if hormonal is ineffective
hysteroscopy, D&C (the good ole' Look and Suck)
56
if hysteroscopy, D&C is ineffective and NOT worried about baby making
endometrial ablation | hysterectomy

Reproductive Exam 2 (5 decks)

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