Normal?
The normal number of days a menstrual cycle should last.
What is 21-35 days?
A structure within the uterine lining that causes bleeding from unstable tissue.
Every women with abnormal uterine bleeding should be evaluated with what test?
What is a pregnancy test?
First line treatment in an 18 y/o female with irregular and heavy menses since onset at age 13.
What are oral contraceptives?
A 53 y/o female with a history of menopause at age 51. Has experienced 3 months of intermittent bleeding. FSH and Estradiol levels are consistent with menopause. Ultrasound is performed which shows a 1cm lesion within the cavity of the uterus. This would be an appropriate next step in evaluation.
What is a Hysteroscopy Dilation and Curettage?
The amount of bleeding that is considered too much.
What is > 80 mL per cycle?
What is a leiomyoma (fibroid)?
This is found after hysteroscopy of a patient with heavy menses.
What is an endometrial polyp?
This is the preferred method for a 37 year old female with heavy menses whose medical history includes tobacco use and hypertension, controlled with Metoprolol. Patient is not interested in any implants and has gained 30 lbs in the past with use of Depo Provera.
What is Progesterone only Pill?
This is the most definitive intervention for abnormal uterine bleeding.
What is hysterectomy?
The dominant hormones involved in the changes of the endometrium that result in menses.
What are estrogen and Progesterone
The cause of bleeding in a woman who has been on Depo-Provera for the past 3 years.
What is iatrogenic?
This should always be done in a post-menopausal patient with bleeding and endometrial thickness greater than 4mm.
What is an endometrial biopsy
A 25 y/o female is 18 months status post Nexplanon insertion for contraception and has frequent episodes of breakthrough bleeding, especially with intercourse. Has tried scheduling Motrin without improvement. Denies tobacco use, migraine with aura. No significant personal or family medical history. Ultrasound is performed which shows an endometrial lining of 2mm. This can be prescribed to treat her irregular bleeding.
What is add back Estrogen therapy?
A 48 y/o female with a history of heavy menses. Endometrial biopsy is negative for hyperplasia or malignancy. Has had an IUD in the past which caused irregular bleeding. Is unable to take extended time off of work. This intervention would be reasonable to offer for this patient.
What is an endometrial ablation?
The layer of the endometrium that thickens during the proliferative phase and is shed during the menstrual phase.
What is the functionalis
This is the most common cause of abnormal bleeding presenting by age group. (immature HPO axis in adolescence, PCOS in reproductive years and perimenopause after age 40)
What is anovulation?
This should be performed in a female who presents with irregular bleeding following intercourse with a new partner with intermittent condom use.
What is gonorrhea and chlamydia testing?
This can be used to manage heavy bleeding in a woman who does not desire to prevent pregnancy.
What is Tranexamic Acid (Lysteda)?
What is a hysterectomy for hematocolpos.
The resolution of this structure results in the onset of menses.
What is coagulopathy?
What is PCOS workup (includes testosterone, 17 (OH) progesterone, DHEA-s, TSH, prolactin)?
A 42 y/o female with a history of endometriosis and uterine fibroids presents with heavy menses. She has tried oral contraceptives, experienced a spontaneous expulsion of an IUD. Patient would like to avoid surgical procedures. This is a once a month option for treatment of both fibroids and endometriosis.
What is Depo Lupron?
A 42 y/o female with a history of a 4cm uterine fibroid has tried Oral contraceptives, and IUD and Depo Lupron with bleeding in between. Does not desire surgical intervention.
What is uterine artery embolization?