LM 13.2: Anovulatory Cycles and Abnormal Uterine Bleeding Flashcards
(37 cards)
why are anovulatory uterine bleeding and irregular periods common during gate first few years after menarche?
immaturity of which renders it incapable of naturally responding to estrogen with a LH surge HPO axis
regulatory which renders it incapable of naturally responding to estrogen with a LH surge
what are some of the common causes of irregular menses in adolescence?
- beginning of menarche; anovulation
- coagulation disorders
- psychosocial stress
- exogenous hormone use
- pregnancy
what are common causes of irregular menses in women of reproductive age?
- pelvic infections from STDs
- endometrial polyps or submucous myxomas
- exogenous hormone use
- pregnancy
- anovulation
- fibroids
- thyroid dysfunction
the cause of abnormal bleeding in women of reproductive age is often benign, malignancy is always a possibility, particularly if the woman is obese or has a history of chronic oligoovulation or anovulation
what are common causes of irregular menses in perimenopausal women?
- increased incidence of anovulatory cycles due to depletion of the store of ovarian oocytes
- endometrial hyperplasia, cancer, polyps, or submucosal fibroids become more prevalent, and pathologic endometrial tissue should be suspected in the perimenopausal woman with abnormal bleeding
what are the risk factors associated with cancer in perimenopausal women?
- obesity
- HTN
- DM
- chronic an ovulation
what are the common causes of vaginal bleeding in menopausal women?
- endometrial hyperplasia
- polyps
- sub mucous fibroids
- exogenous hormone use
- endometrial lesions including cancer
- atrophic vaginitis
any vaginal bleeding in menopausal women should be considered abnorma
what is the difference between abnormal uterine bleeding and anovulatory uterine bleeding?
when AUB cannot be attributed to an anatomic, organic or systemic lesion or disease it is referred to as anovulatory uterine bleeding
it is a diagnosis made by excluding all other possible causes, such as leiomyomas, polyps, malignancy, coagulopathies, etc
anovulatory uterine bleeding is a more descriptive term, reflecting the fact that many of these women suffer from chronic anovulation or oligoovulation
what is ovulatory abnormal uterine bleeding?
abnormal uterine bleeding without any attributable anatomic, organic, or systemic cause but associated with regular ovulation
it occurs when there is loss of local endometrial hemostasis
not common at all…
it is generally observed with regular progesterone-withdrawal menses every 24-35 days but with excessive blood loss
usually retains existing premenstrual symptoms associated with ovulation such as dysmenorrhea, midcycle pain, breast tenderness, bloating, and irritability
what is the hormonal marker of menorrhagia?
PGE2alpha : PGF2alpha and level of PGI2 are increased in women with menorrhagia
menorrhagia = excessive bleeding
what is anovulatory uterine bleeding?
noncyclic menstrual blood flow that may range from spotty to excessive, is derived from the uterine endometrium due to anovulatory production of sex-steroids, specifically excluding an anatomic lesion
typically caused by estrogen-withdrawal or estrogen-breakthrough bleeding and occurs in the absence of the cyclic production of ovarian progesterone
may occur with the sustained levels of unopposed estrogen associated with PCOS, obesity, immaturity of the hypothalamic-pituitary-ovarian (HPO) axis, and late anovulation
what is the mechanism of anovulatory uterine bleeding?
in the absence of cyclical progesterone and periodic menstruation, the endometrium hyperplastic without the necessary structural support
the hyperplastic, unstructured endometrium is fragile and prone to localized breakage and bleeding
as one site of breakage heals, a different site may break down and bleed. The resulting bleeding is usually erratic—in both timing and volume of blood loss—with alternating periods of amenorrhea
what are the conditions associated with anovulation and abnormal bleeding?
- anorexia nervosa/bullemia nervosa
- recessive physical exercise
- chronic illness
- ovarian insufficiency/premature ovarian failure
- alcohol and other drug abuse
- stress
- thyroid disease
- DM
- androgen excess syndromes like PCOS
what is the mneuominc for structural vs systemic causes of abnormal uterine bleeding?
PALM COINE
STRUCTURAL Polps Adenomyosis Leiomyoma Malignancy
SYSTEMIC Coagulopathy Ovulatory dysfunction Endometrial Iatrogenic
what are the subcategories of abnormal uterine bleeding?
- heavy menstrual bleeding
2. intermenstrual bleeding
what are the normal characteristics of a menstrual cycle?
normal menstrual flow is 5 days
normal menstrual cycle typically lasts between 21-35 days
what is metrorrhagia?
bleeding between cycles
what is polymenorrhea?
bleeding that occurs more often than every 21 days
what is oligomenorrhea?
bleeding that occurs less frequently than every 35 days
what is the HPO axis?
the hypothalamic-pituitary-ovarian axis is when the neuronal nuclei of the hypothalamus to the pituitary gland, which subsequently stimulates the ovaries to produce sex-steroids that act upon the endometrial lining of the uterus
along the HPO axis there is a complex system of positive and negative feedback signals that allow the end-organs to communicate with the higher centers
what is classified as a positive screening for an underlying disorder or hemostasis with AUB?
- heavy menstrual bleeding since menarche
- one of the following
- postpartum hemorrhage
- surgery-related bleeding
- bleeding associated with dental work - two or more of the following symptoms
- bruising one to two times per month
- epistaxsis one to two times a month
- frequent gum bleeding
- family history of bleeding symptoms
what are the medical treatments for management of AUB?
- iron
- antifibrinolytics
- cyclooxygenase inhibitors
- progestins
estrogens + progestins (OCs) - parenteral estrogens (CEEs)
- androgens
- GnRH agonists and antagonists
- antiprogestational agents
when would you treat AUB with iron?
if they are bleeding more than 60 mL per cycle because they could get iron deficiency anemia
how are antifibrinolytics used to treat AUB?
fibrinolysis is the breakdown of clots so antifibrinolytics would help you not to bleed
ex. tranexamic acid
who benefits from the administration of cyclic progestins?
women with anovulatory uterine bleeding, with absence of the post-ovulatory progestagenic luteal phase, are more likely to benefit from the administration of cyclic progestins
