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Definitions and Nomenclature
Pathophysiology
Evaluation
Differential Diagnoses
Clinical Considerations
100
The normal menstrual cycle typically lasts between __ & ___ days
21 & 35 days
100
What is the most common cause of AUB?
Ovulatory Dysfunction
100

What is the first step in evaluation?

History & Physical
100

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

100

What method of imaging may provide more sensitive and specific information regarding intracavitary lesions?


Sonohysterography

200
What do the letters of PALM stand for?

Polyps

Adenomyosis

Leiomyomas

Malignancy and Hyperplasia

200
AUB-O is usually secondary to endocrinopathies. What is one of the most commonly encountered one?
PCOS
200
What lab tests can be conducted?

Pregnancy testing, CBC, TSH, Prolactin

200

Most Common cause of AUB in 19-39 y/o?


PCOS
200

What is the primary goal of endometrial sampling in patients with AUB?

To determine whether cancer or premalignant lesion is present

300
What does the acronym COEIN stand for?

Coagulopathy

Ovulatory Dysfunction

Endometrial

Iatrogenic

Not yet Classified

300
In PCOS, the mechanism of abnormal uterine bleeding is related to what unopposed hormone?
Estrogen
300

Heavy menses at the onset of menarche should prompt what evaluation?


Von Willebrands disease

300

What are other causes of AUB in 19-39 y/o patients?

Name 2

Pregnancy, structural lesions, polyps/fibroids, anovulatory cycles 2/2 PCOS, contraception, or hypersplasia-due to obesity

300

Name 3 risk factors for endometrial cancer in pts >40 y/o?

Nulliparity, HTN, BMI >30, irregular menstruation, and family history

400
What is the NEW descriptive term for menorrhagia?
Heavy Menstrual Bleeding
400
Menstruation is a complex interaction between what structures of the body?
Hypothalamus, Pituitary glad, and ovary
400

What is the imaging modality of choice for evaluation of AUB?

Transvaginal Ultrasonography

In adolescents you can perform a transabdominal U/S

400

What are common causes of AUB in women 40 y/o or older?


Anovulatory bleeding due to declining ovarian function, endometrial hyperplasia, cancer, leiomyomas

400

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

500
What is the NEW descriptive term for metrorrhagia?
Intermenstrual bleeding
500

Three mechanisms have been proposed for the pathophysiology of ovulatory AUB. Name one

1. Abnormal  prostaglandin synthesis and receptor upregulation

2. increased local fibrinolytic activity

3. increased tissue plasminogen activator activity.

500

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

500

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
500

Name three medical management options for treatment of AUB.

Bonus Question (100 points): Name one minimally invasive surgical options to control bleeding in women who have completed childbearing

nonsteroidal antiinflammatory drugs, progestins, combination oral contraceptives, a levonorgestrel intrauterine device, or tranexamic acid.

Surgical: Endometrial ablation