Definitions and Nomenclature
What is the most common cause of AUB?
Ovulatory Dysfunction
What is the first step in evaluation of acute AUB?
Prompt evaluation of hypovolemia and hemodynamic stability. Then history & physical.
What is the most common cause of AUB in patients 13-18 y/o?
Anovulation, due to an immature HPO axis. Other considerations: hormonal contraceptive use, pregnancy, pelvic infection, coagulopathies, or tumors
What method of imaging may provide more sensitive and specific information regarding intracavitary lesions?
Sonohysterography
Menstruation is a complex interaction between what structures of the body?
Hypothalamus, Pituitary gland, Ovary, Uterus
What is the imaging modality of choice for evaluation of AUB?
Transvaginal Ultrasonography
What are common causes of AUB in women 40 y/o or older?
Anovulatory bleeding due to declining ovarian function, endometrial hyperplasia, cancer, leiomyomas
For a patient with persistent AUB and menstrual irregularities 45 y/o or greater, what is the next step in evaluation?
Endometrial biopsy, hysteroscopy with D&C or just D&C
Polyps
Adenomyosis
Leiomyomas
Malignancy and Hyperplasia
This layer of the endometrium lines the uterine cavity, is 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.
What are 3 medications that can be used for acute AUB and name one contraindication to each therapy?
1. conjugated equine estrogen
2. combined oral contraceptives
3. medroxyprogesterone acetate
4. tranexamic acid
Most Common cause of AUB in 19-39 y/o?
What are some additional treatment options for the long term management of AUB?
Hormonal IUDs, OCs, progestin therapy(PO or IM), TXA, NSAIDs
Coagulopathy
Ovulatory Dysfunction
Endometrial
Iatrogenic
Not yet Classified
Heavy menses at the onset of menarche should prompt what evaluation (most common cause)?
Von Willebrands disease (von Willebrand-ristocetin cofactor activity, von Willebrand factor antigen, Factor VIII)
What are other causes of AUB in 19-39 y/o patients?
Name 2Pregnancy, structural lesions, polyps/fibroids, anovulatory cycles 2/2 PCOS, contraception, or hypersplasia-due to obesity
What medication can be utilized in the case of von Willebrand disease?
Desmopressin (long term management)
Recombinant factor VIII and von Willebrand factor (acute management)
Avoid NSAIDs (2/2 effects on platelet aggregation)
How do we define chronic AUB?
AUB present for most of the previous 6 months
What is the mechanism of TXA?
Prevent fibrin degradation
After laboratory testing and imaging, what is the next step for establishing the diagnosis of AUB?
Hysteroscopy or saline infused sonohysterography, possible endometrial biopsy, to evaluate structural causes of AUB
In women aged 40 years to menopause, abnormal uterine bleeding may be due to anovulatory bleeding, due to what normal physiologic response?
Declining Ovarian Function
Name one minimally invasive surgical option to control bleeding in women who have completed childbearing. What would you want to rule out prior to completing this surgical procedure?
Surgical: Endometrial ablation
Want to rule out hyperplasia or malignancy