1
Q
Menorrhagia
A
Blood loss of >80mL per cycle
FREQUENTLY PRODUCES ANEMIA
2
Q
Metrorrhagia
A
Bleeding between periods
3
Q
Polymenorrhea
A
Bleeding that occurs more often than every 21 days
4
Q
Oligomenorrhea
A
Bleeding that occurs less often than every 35 days
5
Q
Labs for AUB
A
- CBC
- UPT
- Thyroid tests
- Coagulation studies in adolescents with + heavy bleeding or adults with + screening hx
- Vaginal or urine sample (rule out Chlamydia)
6
Q
PALM-COEIN
A
P - Polyp
A - Adenomyosis
L - Leiomyoma
M - Malignancy and hyperplasia
C - Coagulopathy O - Ovulatory dyscfunction E - Endometrial I - Iatrogenic N - Not yet classified
7
Q
Dx of AUB
A
- Hx of duration and amount of flow
- Hx of systemic infections, thyroid disease, weight change
- Medications: warfarin, heparin, exogenous hormones
- Herbal remedies: ginkgo, motherwort, ginseng
- Hx of coagulation disorders
- Complete physical exam (look for excessive weight, PCOS, thyroid disorder, insulin resistance)
- Pelvic exam: rule out vulvar, vaginal, or cervical lesions; pregnancy; uterine myomas; adnexal masses; adenomyosis; or infection
8
Q
Adolescents with AUB
A
- Often occurs as a result of persistent anovulation due to immaturity of the HPO Axis and is normal physiology
9
Q
AUB Causes
Ages 19-39
A
- Pregnancy
- Structural lesions
- Anovulatory cycles
- Use of Hormonal contraceptive
- Endometrial hyperplasia
10
Q
Taking a Menstrual History
- All Patients
A
- Age of menarche
- Cycle Length
- Duration of bleeding
- Perception of flow: light, medium, heavy
- Menstrual product use
- First day of LMP
- Dysmennorrhea
11
Q
Taking a Menstrual History
- Patients reporting HMB
A
- Soaking through pad/tampon in 1h for 2-3hr in a row
- Passing blood clots >1 inch in diameter
- Double protection: pad and tampon or 2 pads
- Flooding or gushing sensation
- Frequent “accidents” or leaking through protection
- Diagnosed with anemia in past?
12
Q
Treatment for AUB
- Mild (<3 months and Hgb normal)
A
- Observation
- Keep calendar
- Use antiprostaglandin meds (NSAIDS and Mefenamic Acid) to decrease menorrhagia
13
Q
Treatment for AUB
- Moderate (Heavy menses, q1-3 weeks, mild anemia)
A
- If not currently bleeding: Cyclic OCP
- Medroxyprogesterone Acetate 10mg QD x 10 days
- Norethindrone Acetate 5mg QD x 10 days
14
Q
Treatment for AUB
- Severe (Prolonged/Heavy bleeding, Anemia Hgb <9)
A
- Admit to hospital if orthosis present or Hgb <7
- Hgb 8-10: Tapering OCPs (30mg ethinyl estradiol/0.3mg norgestrel) use q4h until bleeding stops
- Iron supplement to improve anemia
15
Q
Tranexamic Acid
A
- Used to tx heavy menses for women who may desire to conceive and wish to not have their fertility negatively affected.
16
Q
Contraindications of Tranexamic Acid
A
- Use caution in women with a personal hx of thromboembolism
17
Q
Mefenamic Acid SE
A
- GI Effects
- Not suitable for women who have previously had PUD or who are thought to have HMB d/t coagulation disorder
- If beneficial, may be continued indefinitely
18
Q
NSAIDS in Management of AUB
A
- Limitation of inflammatory mediators is helpful to treat AUB
19
Q
Hormonal Tx of AUB
A
- Maintenance of progesterone exposure limits endometrial inflammation and prevents menstruation
- These are the MOST EFFECTIVE txs available for HMB
20
Q
Injectable Progesterone
A
- Offers women alternative to pills or IUD
- Excellent for women who experience frequent or irregular HMB
- CAUTION: slight reduction in bone mineral density with long-term use
21
Q
GnRH Agonist
Delivery system and Dose
A
- IM, SQ, Intranasal
- 5mg TID from day 5-26 of menstrual cycle
22
Q
GnRH Agonist
MOA
A
- Decreases LH/FSH -> Hypogonadal State -> MEDICAL MENOPAUSE
- Reduces amenorrhea rate of up to 90%
23
Q
GnRH Agonist
Uses
A
- Tx of uterine fibroids (leiomyoma) -> reduce size when hormone level suppressed
24
Q
GnRH Agonist
SE
A
- Flushing
- Vaginal Dryness
- HA
- Decreased libido
25
Oral Progesterone
| Most Common
- Norethisterone
26
Oral Progesterone
| Dose
- 5mg tablet TID from day 5-26 of menstrual cycle
27
Levonorgestrel-releasing Intrauterine System
| MOA
- IUD
| - decreases menstrual loss by up to 96% after 1 year of use; tx of HMB for 5 years -> remove and replace with new device
28
Levonorgestrel-releasing Intrauterine System
| Pros
- Does not require patient compliance
| - Reduction of dysmenorrhea
29
Levonorgestrel-releasing Intrauterine System
| Potential Complications
- Unscheduled bleeding: most common during first 3-6 months of use
- Infection: increased risk first 3 weeks after insertion; DO NOT USE TAMPONS
- Expulsion of IUD: highest risk during first 6 weeks after insertion; higher in nulliparous women
- Perforation: rare, occurs 1:1000 cases
30
```
SPRMs
Ulipristal Acetate (UPA)
```
- Restricted to 3 months pretreatment of fibroids prior to surgical intervention
- Effective in treating HMB associated with uterine fibroids (3-10cm in size)
- Control of HMB achieved significantly quicker than with GnRH Agonist
- SE limited to HA and breast complaints
- No publications currently about clinical utility of SPRM in women who do not have fibroids
31
COCs
| Estrogen and Progestogen
- On 3 weeks, Off 1 week
32
COCs
| Pros
- Excellent for women experiencing frequent or irregular HMB
- Produces estimated reduction of blood loss of 50%
- Regulation of bleeding
33
COCs
| Contraindications
- Women with BMI >35
- Smokers over 35 yo
- HTN
- Vascular disease
- Migraines with aura
- Current/Recent breast cancer
- Personal or strong fam hx of venous thromboembolism
34
Progesterone Only Pill
- Not recommended for HMB treatment
CMN 572 Module 4
flashcards
Decks in class (3)
# Cards
