Miscellaneous
"PALM-COEIN" stands for these 9 common etiologies of AUB:
What are: polyps, adenomyosis, leiomyoma, malignancy, hyperplasia, coagulopathy, ovulatory dysfunction, endometrial, iatrogenic, not yet classified?
This layer of the endometrium lines the uterine cavity, is very hormonally responsive, and ultimately sloughs during menstruation
What is the functionalis layer?
*The basalis layer lies beneath the functionalis, is in direct contact with the myometrium, and is less hormonally responsive.
Etiology bleeding associated with heavy menses, h/o post-partum hemorrhage, frequent epistaxis
What is COEIN (coagulopathy)
These are routine tests (name at least 3) involved in the workup for abnormal uterine bleeding in a 50 yo female
What are: pregnancy test, TSH, Prolactin, EMB, TVUS/SIS, CBC
Progestins improve heavy menstrual bleeding by this mechanism
What is stabilizing the endometrial lining, restricting growth (antagonizing estrogen). A progesterone withdrawal can also allow for organized sloughing.
Blood is supplied to the uterus mainly by the uterine and ovarian arteries, which are branches of these arteries, respectively.
What is the hypogastric (internal iliac) and the aorta.
Etiology of PCOS bleeding
What is COEIN (nonstructural, anovulatory bleeding) +100 points if team said BOTH; PCOS also increases risk of hyperplasia/malignancy (PALM,)
An endometrial stripe in a postmenopausal women of this thickness ( mm) can be used to virtually rule out cancer
What is 4mm or less
Lupron treatment is usually limited to 6 months for this reason
What is bone loss
Thyroid dysfunction can cause AUB through this physiologic mechanism
What is H-P-O axis/anovulation. +300 if team mentions decreased coagulation factors seen in some hypothyroid pts.
Etiology of hypothyroid bleeding
What is COEIN (anovulatory bleeding)
To biopsy or not to biopsy? Per ACOG, a pt younger than 45 yrs should receive an Endometrial Biopsy if she meets these 3 criteria
What is persistent AUB, failed medical management, h/o unopposed estrogen exposure
Conjugated equine estrogen (Premarin) can be given for this condition
Acute menorrhagia
First-line therapy for breakthrough bleeding in Pt’s with a Mirena IUD
What is… NSAIDS
This is the mechanism by which anovulation causes irregular bleeding
What is unopposed estrogen. In the absence of ovulation, a corpus luteum does not develop and the ovary fails to secrete progesterone. This results in continual endometrial proliferation without progesterone-withdrawal-induced shedding and bleeding. The clinical result is bleeding that is noncyclic, unpredictable, and inconsistent in volume. The endometrium that develops in the milieu of unopposed estrogen is fragile, vascular, and lacking sufficient stromal support. As one area of bleeding begins to heal, another area begins to slough, which results in erratic bleeding patterns.
Etiology of bleeding associated with bilateral hemianopsia and galactorrhea
What is COEIN (anovulatory bleeding, hyperprolactinemia, pituitary adenoma)
Chronic blood loss causes this type of anemia, and is associated with these lab findings (please list at least 3)
What is Iron deficiency anemia. Low Hgb, low Hct, Low MCV, Low MCH, low MCHC, low ferritin, low serum iron, high TIBC.
NSAIDS may improve heavy menstrual bleeding by this mechanism
What is downregulation of prostaglandins. Note: chronic NSAID use can eventually inhibit platelet function and cause the opposite effect.
What are the 4 phases of the menstrual cycle in chronological order
Menstrual, Follicular, Ovulation, Luteal
At the end of a menstrual cycle, progesterone levels drop and cause the release of these factors that are responsible for the breakdown of the stroma integrity
What are matrix metalloproteinases.
Etiology of bleeding associated with abnormal saline-infused-sonogram results
What is PALM (structural-polyps, fibroid, malignancy)
These findings can distinguish polyps from fibroids on Doppler Ultrasound
What is number of feeding vessels. Polyps usually have only one arterial feeding vessel, while fibroids generally receive blood from several vessels within myometrium
Being color-blind is a contraindication for the usage of what drug used to treat acute AUB?
What is Tranexamic acid. Mech of action: antifibrinolysis. TA reversibly blocks binding sites on plasminogen decreased plasmin decreased fibrinolysis fibrin stays intact, bleeding prevented. Theoretical increased risk of VTE, use with caution.