Controlling the Flow
While traditionally defined as menstrual blood loss greater than 80 mL for research purposes, in clinical practice, the assessment of this specific bleeding pattern is based primarily on the patient's perception
What is menorrhagia?
In the PALM-COEIN classification system, this specific nonstructural etiology is represented by the letter 'O'.
These two distinct conditions are frequently identified as precursor lesions to adenocarcinoma of the endometrium.
What are Endometrial Intraepithelial Neoplasia and Atypical Endometrial Hyperplasia?
Despite the many benefits of office hysteroscopy, this specific perioperative complication is the most common, with risk factors including cervical stenosis and uterine malposition.
What is uterine perforation?
For postmenopausal women experiencing bleeding, an endometrial thickness of this specific measurement or less has a negative predictive value greater than 99% for endometrial cancer.
Within the PALM-COEIN classification system, P, A, L, and M represent these specific categories of etiologies, which are related to structural abnormalities
What are Polyp, Adenomyosis, Leiomyoma, and Malignancy?
The fundamental hormonal imbalance leading to AUB-O is the chronic presence of this unopposed steroid on the endometrium, preventing organized shedding.
What is estrogen?
For patients who wish to preserve fertility or are not surgical candidates, this class of hormonal agents is the primary conservative management strategy for EIN/AEH.
What are progestins?
For premenopausal women with regular cycles, the optimal time to perform diagnostic hysteroscopy is during this specific phase of the menstrual cycle.
What is the follicular phase?
For a postmenopausal woman with persistent or recurrent bleeding, this further diagnostic step is warranted even if TVUS shows an apparent thin endometrial echo.
What is histologic evaluation (or endometrial sampling/hysteroscopy with D&C)?
This imaging technique is described as superior to transvaginal ultrasonography for detecting intracavitary lesions like polyps and submucosal leiomyomas, enabling better distinction between focal and uniform endometrial thickening.
What is sonohysterogrpahy?
This surgical intervention is generally not recommended as a first-line therapy for AUB-O due to its endocrinologic nature, and it raises concerns about the future detection of endometrial cancer and its lack of contraceptive effect.
What is an endometrial ablation?
The updated classification system, introduced in 2014, simplified endometrial precancer nomenclature into these two main tiers.
What are hyperplasia without atypia and atypical hyperplasia (or EIN)?
While electrolyte-containing fluids are used for their isotonic properties, this specific category of distending media, such as glycine or sorbitol, carries the risk of hyponatremia and cerebral edema if excessively absorbed.
What are electrolyte-poor (or hypotonic) fluid media?
If transvaginal ultrasonography cannot adequately provide a clear endometrial thickness measurement in a postmenopausal woman with bleeding due to factors like an axial uterus, obesity, or myomas, these additional imaging or sampling methods should be triggered (3).
What are sonohysterography, office hysteroscopy, or endometrial sampling?
While combined oral contraceptives and oral progestins are common medical management options, this specific intravenous medication is the only one explicitly approved by the U.S. Food and Drug Administration for the treatment of acute AUB.
What is intravenous conjugated equine estrogen?
Adolescents commonly experience AUB-O due to the immaturity of this specific axis, leading to insufficient hormonal feedback for consistent ovulation.
What is the hypothalamic-pituitary-gonadal axis?
When attempting to exclude concurrent carcinoma in individuals with EIN-AEH, this diagnostic procedure combined with further endometrial sampling is cited as the most accurate method.
What is hysteroscopic examination?
Excessive absorption of distending fluid during hysteroscopy, particularly with hypotonic media, can lead to severe complications such as these.
What are hyponatremia, pulmonary edema, seizures, cerebral edema, and death?
In the United States, this specific type of cancer is identified as the most common gynecologic malignancy.
What is endometrial adenocarcinoma?
When an underlying hemostatic disorder is suspected in a patient with excessive menstrual bleeding, further evaluation includes consultation with a hematologist and specific testing for these two critical blood factors
What are von Willebrand factor and ristocetin cofactor?
When medical management for AUB-O has failed, this procedure is recommended for further investigation.
What is hysteroscopy?
A significant percentage, ranging from 30% to nearly 50%, of patients diagnosed with EIN-AEH are found to have this more serious condition concurrently upon hysterectomy, making hysteroscopic examination with further sampling the most accurate detection method prior to definitive surgery.
What is concurrent endometrial carcinoma?
According to guidelines for fluid monitoring during hysteroscopy, these are maximum fluid deficit in healthy patients for isotonic and hypotonic solutions, respectively.
What is 2,500 mL (for isotonic solutions) and 1,000 mL (for hypotonic solutions)?
When evaluating postmenopausal bleeding, clinical risk factors for endometrial cancer include age, obesity, unopposed estrogen use, and these two specific medical comorbidities.
What are PCOS and type 2 DM?