Term
| what is an all-encompassing diagnosis referring to any uterine bleeding that is irregluar in amount, frequency, duration or timing? |
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Definition
| AUB- abnormal uterine bleeding |
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Term
| what is bleeding or spotting between normal menses, flow is usually light |
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Definition
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Term
| what is excessive amount or prolonged duration of bleeding in excess of 80 ml at regular intervals? |
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Definition
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Term
| what is heavy prolonged menstrual bleeding at irregular intervatls |
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Definition
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Term
| what is uterine bleeding that is excessive in flow or duration or both at irregular intervals |
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Definition
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Term
| what is decreased scanty flow at intervals greater than 35 days? |
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Definition
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Term
| what is regular, frequent menstruation at intervals less than 24 days |
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Definition
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Term
| What is a term typically used to escribe abnormal bleeding for which no pelvic pathology or underlying medical caus is found? |
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Definition
| DUB- dysfunctional uterine bleeding |
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Term
| What is a normal range of days for cycle interval |
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Definition
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Term
| what is a normal number of days for menstrual flow |
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Definition
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Term
| what is the most common cause of bleeding pattern that is suddenly different froma woman's established menstrual pattern |
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Definition
| a complication of pregnancy (treatened or incomplete AB, ectopic, retained POC, molar preg) so always exclude this first |
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Term
| what types of menses are associated with heavy, irregular bleeding |
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Definition
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Term
| is ovulatory or anovulatory AUB more common? |
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Definition
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Term
| If a cycle is anovulatory, what phase of the menstrual cycle is the woman constantly in? |
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Definition
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Term
| What are endocrine causes of AUB |
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Definition
| Thyroid disease, pituitary disease, PCOS, adrenal hyperplasia, cushings, diabetes |
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Term
| What medications can cause AUB |
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Definition
| amphetamines, anticoagulants, anyipsychotics, benzo's, corticosteroids, hormone therapy (tamoxifen), isoniazid, SSRI's |
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Term
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Definition
| yes, ginko, ginsing, soy and especially bromelain |
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Term
| POF, PCOS, postmenarche, perimenopause, stress, eating disorders, severe dieting /weight loss, excessive exercise all cause problems with the_______ that can lead to AUB |
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Definition
| hypothalamic-pituitary-ovarian axis |
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Term
| What disorder do you want to look for in a woman >35 or obese women with DUB? |
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Definition
| endometrial hyperplasia (from prolonged estrogen exposure) |
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Term
| What infections may cause irregular spotting d/t irritation and inflamation of the tissues of the cervix or endometrium |
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Definition
| gonorrhea, chlamydia, endometritis |
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Term
| what benign gyn abnormalities may cause heavy or abnormal bleeding? |
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Definition
| fibroids, adenomyosis, cervical polyps |
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Term
| why would it be important to assess for violence in DUB? |
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Definition
| trauma could cause lacerations/injuries |
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Term
| If a woman taking OCP's for the first time presents with AUB, what should you assess? |
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Definition
| that she is taking them correctly |
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Term
| DUB diagnosis can be made based on menstrual history alone if no other risk factors are present and the patient has irregular, unpredictable bleeding in the absence of ____? |
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Definition
| Molimina (PMS symptoms/ bloating fatigue constipation and mood changes) which are likely d/t higher levels of progesterone that does not occur in anovulatory cycles |
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Term
| Is the passing of clots accompanied by heavy bleeding a reliable indicator for heavy bleeding? |
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Definition
| Yes, counting pads or tampons has not been shown to be helpful |
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Term
| Is it abnormal for a woman to report a change in the duration of flow from her normal? |
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Definition
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Term
| A woman presents stating she is having regular cycles that have now become heavy and are acocompanied by the passage of clots and notices the sensation of pelvic fullness, what should you suspect as the cause |
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Definition
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Term
| what symptoms could you ask about to reveal hormone disorders? |
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Definition
cold intolerance, fatigue, hyperactivity, weight loss or gain for thyroid
hair loss, changes in breast size, hirsuism, headache, breast discharge for hormone-secreting tumors |
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Term
easy bruising, petechiae, weight or appetite changes or changes in elimination patterns may be a sign of which of the following?
A. medication induced AUB
B. HPA axis disruption
C. systemic disease |
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Definition
| Systemic disease (coagulation defects, von Willebrand, leukemia, ideiopathic thrombocytopenia, liver disease, renal disease) |
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Term
| If a patient has pale skin, delayed capillary refill on exam and a history of heavy bleeding, what should you assess for? |
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Definition
| anemia (CBC-Hg<10), serum iron/ferriten |
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Term
| What cause of AUB may a breast exam help you rule out? |
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Definition
| galactorrhea/pituitary tumor |
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Term
| Can you defer a pelvic exam on an adolescent with AUB who is not sexually active? |
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Definition
| Yes, as long as the patient only recently began menstruating and has a normal hematocrit |
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Term
| Should you do a speculum exam and bimanual for women who are not adolescents? |
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Definition
| Yes! look for infection, trauma, foreign objects w/ speculum, look for tumors, vervical polyps, ovarian cysts, uterine tenderness or enlargement, adenexal pain or masses with bimanual |
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Term
| what lab test would help you to assess Von Willebrand disease if a patient has a hx of easy bruising or family hx of bleeding d/o (also assess for leukemia and prothrombin deficency) |
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Definition
| PT/aPTT- bleeding time increased |
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Term
| what hormone level would help you to assess for an anovulatory cycle |
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Definition
| progesterone (less than 10ng/ml)between days 22 and 24, order if the menstrual hx does not indicate whether a woman is ovulating |
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Term
| what lab test helps to r/o pituitary adenoma |
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Definition
| prolactin (>100ng/ml) order if headaches, glactorrhea, peripheral vision changes |
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Term
| what test would help test for clotting abnormalities |
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Definition
| platelets less than 150,000 |
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Term
| What hormone level could help to show amenorrhea d/t menopause or POF |
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Definition
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Term
| What causes of AUB can TVS assess for? |
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Definition
polyps, submucosal fibroids, measure endometial thickness, evaluate for pregnancy complications, assess ovarian masses
good first line diagnostic tool |
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Term
| What extra diagnostic test do you want tod o in a woman who has AUB and is perimenopausal, postmenopausal, adoselcents who are obeses and have long term (3+ years) of unexplained abnormal bleeding, or any women whose endometrium has been exposed to unopposed estrogen? |
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Definition
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Term
| If the patient has heavy bleeding that is resulting in hemodynamic instability, what should you do? |
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Definition
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Term
| For acute DUB that is not emergent, how should you treat? |
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Definition
| any monophasic OCP q 12 H until bleeding stops (or 10 days)then continued with rest of package with one pill a day |
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