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Managing Abnormal Menses

Managing Abnormal Menses. Caroline Hewitt, RNC, MSN, NP Director Clinical Education Cicatelli Associates. Objectives. Clarify terminology related to abnormal uterine bleeding (AUB) Identify possible causes of (AUB) Discuss evaluation plan for AUB Review management for specific diagnosis.

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Managing Abnormal Menses

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  1. Managing Abnormal Menses Caroline Hewitt, RNC, MSN, NP Director Clinical Education Cicatelli Associates

  2. Objectives • Clarify terminology related to abnormal uterine bleeding (AUB) • Identify possible causes of (AUB) • Discuss evaluation plan for AUB • Review management for specific diagnosis

  3. Terminology • Dysfunctional uterine bleeding • Menorrhagia • Oligomenorrhea • Polymennorhea • Metrorrhagia/menorragia • Intermenstrual bleeding • Premenstrual spotting • Post coital spotting

  4. What is normal?

  5. What is abnormal? • Not bleeding • Amenorrhea • Primary vs secondary • Bleeding unpredictably • AUB

  6. Where is the bleeding?

  7. Why is it bleeding? • Pregnancy • Anatomic anomaly • Fibroid, polyp, adenomyosis • Endocrine • Malignancy • Infection • Bleeding disorders • Drugs

  8. Stages of life

  9. History • Significance of good history taking! • Cyclic versus non-cyclic bleeding • Characterization of bleeding and amount • Associated moliminal symptoms • Medications • Sexual history

  10. Amenorrhea • Secondary • No menses for more than three cycles or six months • Rule out pregnancy • Other causes: • Ovarian disease • Hypothalamic dysfunction • Pituitary • Uterine disease • other

  11. Ovarian Dysfunction • Polycystic ovarian syndrome • Associated characteristics • Hair growth, truncal obesity, diabetes • Sonographic findings • Free testosterone / DHEAS ?

  12. Endocrine Disorder • Thyroid dysfunction • Hyperprolactinemia • Hyperandrogenemia

  13. Evaluation • BMI • Tanner stage • S&S Virilization • Vulvar/vaginal/cervical lesions • Uterine/adnexal tenderness • Cultures/labs

  14. Cultures/Labs • Urine pregnancy test • Pap (if indicated) • GC/Chl • Endo bx (if indicated) • Transvaginal ultrasonography (if indicated) • Bloods for systemic/endocrine disease

  15. Gertie • 16 year old high school student presents complaining that, “ I have not had a period for 5 months”. • She is 5’2’’ and 132 lbs •  PMH/PSH,  meds

  16. Gertie • What further information would you like to have? • Initial differential? • How would you approach your PE? • What labs/tests would you perform? • Using your presumptive dx, what plan would you make for Gertie?

  17. Conclusion • Summary • Questions • Comments • Thank you! • chewitt@cicatelli.org

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