abnormal uterine bleeding - stritch.luc.edu
TRANSCRIPT
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ABNORMAL UTERINE BLEEDING
Lena Wiley, MD
April 20, 2020
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OBJECTIVES
• Menstrual Cycle
• Diagnosis of Abnormal Uterine Bleeding
• Leiomyoma
• Ovulatory Dysfunction
• Management Options of Abnormal Uterine Bleeding
• Sequelae of Abnormal Uterine Bleeding
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MENSTRUAL CYCLE
• What is considered to be normal menstrual cycle?
• Duration, Frequency, Quantity
https://worldbuilding.stackexchange.com/questions/113010/ovulation-
dependent-menstrual-cycle
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NOMENCLATURE of AUB
• Menorrhagia - heavy menstrual bleeding
• Metrorrhagia - intermenstrual bleeding
• Polymenorrhea
• Oligomenorrhea
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PALM (structural)
Polyp
Adenomyosis
Leiomyoma
Malignancy
COEIN (nonstructural)
Coagulopathy
Ovulatory
Endometrial
Iatrogenic
Not Otherwise Specified
DIAGNOSIS
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LEIOMYOMA
https://westlondongynaecologyclinic.co.uk/services/fibroids/
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LEIOMYOMA
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MECHANISMS
• Unopposed estrogen
• Abnormal prostaglandin synthesis and receptor upregulation
• Increased local fibrinolytic activity
• Increased tissue plasminogen activator activity
OVULATORY DYSFUNCTION
https://en.wikipedia.org/wiki/Tissue_plasminogen_activator
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DIAGNOSIS
• Medical History
• bleeding disorder, medications, family history
• Physical Exam
• ecchymoses, hirsutism, goiter, acanthosis nigricans, enlarged uterus or cervical polyp on pelvic exam, pap smear, endometrial sampling
• Laboratory Testing
• CBC, TSH, Gonorrhea/Chlamydia, von Willebrand, HCG
• Imaging
• pelvic ultrasound (transvaginal preferable), saline sonohysterography, hysteroscopy, MRI (not first line)
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SALINE SONOHYSTEROGRAM
http://www.advancedwomensimaging.com.au/saline-sono-hysterogram
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MANAGEMENT: AUB-O
• Progestin-only therapies
• Levonorgestrel-releasing intrauterine system, medroxyprogesterone acetate (provera), megesterol acetate (megace), norethrindroneacetate, depot medroxyprogesterone acetate
• Combined hormonal contraceptives
• Oral contraception, vaginal ring (nuva ring), transdermal patch
• U.S. Medical Eligibility Criteria for Contraceptive Use
• Weight Loss
• NSAIDs
• Endometrial Ablation
• Hysterectomy
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MANAGEMENT: AUB-L
• Medical Management with progesterone/estrogen
• Myomectomy
• Laparoscopy, laparotomy, hysteroscopy (i.e. myosure)
• Pros and Cons
• Uterine Artery Embolization
• Hysterectomy
• Laparoscopy, laparotomy, vaginal (preferred approach)
• Pros and Cons
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SEQUELAE
• Chronic anemia
• Emergency procedures
• Quality of life
• Fertility
• Chronic pelvic pain
• Malignancy
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QUESTIONS
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REFERENCES
Diagnosis of Abnormal Uterine Bleeding in Reproductive-Aged Women
ACOG Practice Bulletin, Number 128, July 2012
Management of Abnormal Uterine Bleeding Associated With Ovulatory Dysfunction
ACOG Practice Bulletin, Number 136, July 2013