Definition & Nomeclature
Definition of AUB
What is having a menstrual flow outside of normal volume, duration, regularity, or frequency
One of the first things we review during initial evaluation
What is medical history
Many causes of abnormal bleeding are amenable to medical management with
What is hormonal therapies (COCs, LNG-IUD, Provera/Aygestin etc)
Levels of this hormone fall at the end of the menstrual cycle, leading to enzymatic breakdown of the endometrium
What is Progesterone
The average amount of the lining that is sampled when performing an endometrial biopsy
What is 10-25%
Old term for intermenstrual bleeding or bleeding between periods
What is metrorrhagia
Primary imaging to assess AUB
What is Transvaginal ultrasound
Definitive management for AUB
What is a hysterectomy
Most common cause of AUB in the postmenopausal woman
What is atrophy (vaginal and endometrial)
In adolescents, AUB most frequently occurs as a result of
What is persistent anovulation due to the immaturity of the HPO axis
New classification system for AUB developed by FIGO in 2011
What is PALM-COEIN
A detailed GYN history includes
What is age of menarche/menopause, menstrual bleeding pattern, menstrual symptoms, pap hx/HPV vaccine, STI hx, sexually hx (with? and issues?), contraception
Minimally invasive surgical options
What are operative HSC and endometrial ablation
Origin of the uterine artery
What is the anterior branch of the internal iliac artery
Most common cause of AUB-O in reproductive age women
What is PCOS
The amount of blood loss (in ml) that is considered "heavy menstrual bleeding"
What is menstrual blood loss greater than 80ml
Laboratory Assessment of AUB
What is UPT, CBC, TSH, A1C, GC/CT/Trich, Targeted screening for bleeding disorders
When performing a HSC myomectomy for a patient with AUB-L you must be mindful of
What is the fluid deficit
Layers of the endometrium
What are the stratum basalis and stratum functionalis
IV estrogen is commonly used to treat ACUTE AUB in adolescents (PAG patients). It is derived from...
What is the urine of pregnant horses
Term used synonymously with AUB in literature to indicate AUB for which there was no systemic or locally definable structural cause
What is dysfunctional uterine bleeding
According to ACOG, endometrial tissue sampling should be performed in what patients with AUB
What are patients older than 45 or younger than 45 with a hx of unexposed estrogen (Obesity, PCOS), failed medical management, and or persistent AUB
...PMB?
Uterine fibroid embolization is a minimally invasive procedure done by IR that uses of fluoroscopy to inject synthetic particles into arteries supplying fibroids...cut off blood flow and causes fibroids to shrink. What are some contraindications to this procedure?
Malignancy, IUP, PMB of undiagnosed etiology, active endometritis or infection, coagulopathic, desires future fertility, contrast allergy or renal insufficiency, fibroid size (small/multiple, >10cm or uterus >24wk)
Arteries that supply the endometrium
basal (basalis) and spiral arteries (functionalis)
Famous study that looked at endometrial ablation vs hysterectomy
What is the STOP-DUB Trial (Published in 2007)