Dysfunctional Uterine Bleeding Flashcards Preview

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Flashcards in Dysfunctional Uterine Bleeding Deck (43)
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1

Normal uterine bleeding

-cycle is 21-35 days, average is 28 days
-bleeding lasts 2-7 days
-40 mL blood loss

2

Menorrhagia

-HEAVY bleeding
> 7 days
> 80 mL blood loss (double normal)

3

Metorrhagia

-ABNORMAL bleeding
-Polymenorrhea: 35 days

4

Menometorrhagia

Both heavy and abnormal bleeding

5

PALM-COEIN reasons for premenopausal uterine bleeding

PALM: Structural
P: poly
A: adenomyosis
L: leiomyoma
M: malignancy

COEIN: non-structural
C: coagulopathy
O: ovulatory dysfunction
E: endometrial
I: iatrogenic
N: not yet classified

6

Polyp

**Can cause very heavy bleeding (menorrhagia) or intramenstrual bleeding (bleeding between cycles)**

-Localized hyperplastic overgrowths of endometrial glands and stroma around a vascular core
-Looks like a finger-like projection into uterus

7

Risk Factors to getting a uterine polyp

-tamoxifen (breast cancer)
-obesity (have extra estrogen)
-postmenopausal hormones

8

To better view a polyp can use

Saline infused sonohistogram (used to
expand uterus to see structures you wont see
when uterus is collapsed)

9

Adeonmyosis

**Heavy menstrual bleeding and pelvic pain
**Trying to bleed but trapped in muscular tissue (painful)
-Endometrial glands and stroma within uterine musculature= hypertrophy and hyperplasia= globular uterus
-can be diffuse or nodular

-WIKI: presence of ectopic glandular tissue found in muscle

10

Best imaging for uterus (especially to see adenomyosis)

Transvaginal ultrasound

11

Treatment for Adenomyosis

medical/surgical
-may need hysterectomy

12

Leiomyoma

-AKA: fibroids
-Benign monoclonal tumors arising from smooth muscle of myometrium
-Heavy menstrual bleeding plus pressure symptoms
-2-3x great risk in african americans

13

Types of Leiomyomas

1. Submucosal fibroid (causes most bleeding, most associated with infertility and miscarriages)
2. Intramural fibroid
3. Subserosal fibroid
4. Pedunculated fibroid

14

Leiomyoma vs Polyp

-Fibroids are more solid and harder to remove
-Polyps are softer and easier to remove because they are endometrial glands
-These two are easily confused
-Can use use saline infused sonohistogram to see both (submucosal fibroid only)

15

Treatment for Leiomyoma

-medical:
1. OCPs
2. Progestins (IUD or Depo- stops ovulation, no growth of endometrium, may decrease bleeding)
3. Luprolide (LOTS of people use this- shuts off all estrogen that you’re secreting, can maybe even shrink the fibroid)- 6 months max, puts you in false menopausal state- causes bone loss, NOT reversible (osteoporosis/osteopenia)
-Once in menopause, no estrogen, fibroids may even shrink

-Surgery: removal

16

Malignancy

Cervical vs uterine (both present with vaginal bleeding)

Uterine- Hyperplasia vs adenocarcinoma vs sarcoma

17

Cervical cancer, you can see _________

squamous cell carcinoma

18

Endometrial hyperplasia

Proliferation of endometrial glands of irregular size and shape

-Hyperplasia is BIG risk factor for endometrial cancer

19

Simple without atypia, % of people with endometrial hyperplasia that have it

1% (penny)

20

Complex without atypia, % of people with endometrial hyperplasia that have it

3% (nickel)

21

Simple with atypia, % of people with endometrial hyperplasia that have it

8% (dime)

22

Complex with atypia, % of people with endometrial hyperplasia that have it

*29% (quarter)

23

Risk factors for endometrial hyperplasia

unopposed estrogen!, increasing age, unopposed E2 therapy, tamoxifen, early menarche, late menopause, nulliparity, PCOS, obesity, diabetes, E2 tumor, lynch syndrome, cowden syndrome, family history

24

Endometrial carcinoma,
Type I

-endometrioid histology, grade 1,2**
-good prognosis, usually can find this early and low grade (pt comes in when they are bleeding- know this is abnormal)

25

Endometria carcinoma,
Type II

-non-endometrioid histology, or grade 3 endometrioid
(Serous, Clear cell, Mucinous, Squamous, Transitional Cell, Mesonephric, Undifferentiated)

-NOT associated with endometrial hypoplasia, poor prognosis, aggressive, usually familial inheritance

26

Coagulopathy

**Von Willebrand disease**= most common
-ITP
-Platelet function defect

CLINICAL: Patients who come in young- really, really heavy periods, mom has really heavy period, gums bleed when they brush their teeth

27

Ovulatory Dysfunction: Primary hypothalamic-pituitrary dysfunction

-Sheehan’s syndrome
-Pituitary adenoma/other tumor
-Lactation
-Stress
-Eating disorders
-Exercise
-Peri-Menopause** (happens 2-6 yrs before menopause)
-Autoimmune diseases
-Empty sella syndrome
-Kallman’s syndrome
-Idiopathic hypogonadotropic hypogonadism
-Hypothalamic/pituitary tumor, trauma or radiation

28

Ovulatory Dysfunction: Other

-Polycystic ovarian syndrome (PCOS- ABNORMAL CYCLES- heavy bleeding, have follicles but nothing is ovulating, no dominant follicle, doesn’t happen every month- lots of androgens= obese, baldness, etc)
-Hyperthyroidism/hypothyroidism
-Adrenal or ovarian tumors
-Liver or renal disease
-Cushings disease
-Congenital adrenal hyperplasia
-Premature ovarian failure
-Turner syndrome
-Androgen Insensitivity syndrome

29

Peri-menopause

not having functional ovulation every cycle, in between you have abnormal growth of endometrium and you’re not having a period, when you DO get a period everything comes out at once

30

Treatment for ovulatory dysfunctions

1. NSAIDS- Start with NSAIDS- block prostaglandins involved with menses
2. Progestins
3. Combined oral contraceptives
4. GnRH agonists
5. Estrogen