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Abnormal Uterine Bleeding MS III Lecture

Abnormal Uterine Bleeding MS III Lecture. James Barrow M.D. Assistant Professor. http://www.youtube.com/watch?v=ShoXnybHl_0&feature=related. AUB . Normal MC- 28 days +/- 7days Cyclic bleeding 3-7 days <80 ml of blood 3 compartments Brain, ovary, endometrium 3 phases

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Abnormal Uterine Bleeding MS III Lecture

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  1. Abnormal Uterine BleedingMS III Lecture James Barrow M.D. Assistant Professor

  2. http://www.youtube.com/watch?v=ShoXnybHl_0&feature=related

  3. AUB • Normal MC- 28 days +/- 7days • Cyclic bleeding • 3-7 days • <80 ml of blood • 3 compartments • Brain, ovary, endometrium • 3 phases • Follicular phase, ovulation, luteal phase

  4. Menstrual Cycle

  5. Differential Diagnosis • Pregnancy • Hormonal changes • Anatomical- adenomyosis, myomas, polyps • Coagulopathy • Infection • malignancy • Systemic causes- thyroid, renal and liver dz • Dysfunctional uterine bleeding

  6. Workup • UPT- usually the first step • History • Physical exam • Lab • EMB • Ultrasound • Cultures

  7. Medical Treatments • OCP’s- endometrial atrophy • Oral progestins- same as above • Estrogen- acute bleeding • NSAIDS-before cycle starts • Levonorgestrel IUD- most effective • GNRH agonists- flare response • Tranxenamic acid- newly approved • Androgens- induce hypoestrogenic environ.

  8. Surgical Treatments • D&C • Rarely used, acute treatment for failed medical treatment • Hysteroscope • Both diagnostic and therapeutic • Ablation • 20-30% end up needing hyst, similar satisfaction • Hysterectomy • UAE • fibroids

  9. Questions • 41 yo G3P2 woman presents with menorrhagia for the last 8 months. Before that she had monthly menses that lasted 4-5 days and were regular. She is currently bleeding for the past 10 days. She has no other significant medical history. On PE she weighs 120 lbs and her BP is 110/73. Her pelvis exam is WNL except for menstrual blood in the vault. Her most recent PAP is WNL and was 4 months ago. Pelvic u/s shows and 8 cm uterus with a 2 x 1 cm mass in the uterine cavity. The adnexa are WNL. TSH and EMB are WNL. • A-endometrial polyp • B-endometrial hyperplasia • C-Fibroids • D-Adenomyosis • E-DUB

  10. Questions • 65 yo female presents to your office complaining of vaginal bleeding. She is post menopausal since age 50. She’s had similar symptoms off and on in the past. This time it was a couple of days of spotting that stopped on its own. Her history is significant for CHTN and fibroids. Her physical exam is WNL and pelvic exam demonstrates a 16 wk size uterus and non-palpable adnexa. There is no blood in the vagina. • Workup? • A- fibroids • B-adenomyosis • C-SARS • D-atrophic vagina • E-malignancy

  11. Questions • A 12 yo female is referred to your office by her pediatrician for irregular heavy menstrual cycles. She had her first period 3 months ago. She has no medical problems and her physical exam is WNL. Pelvic exam is deferred. Upon further questioning, her mother tells you that she had a hysterectomy when after she finished child bearing bc of severe menorrhagia. She also said that she has always bruised very easily and bleeds frequently from her gums after careful questioning? • A-malignancy • B-renal disease • C-endometrial polyp • D-infection • E-von willenbrands

  12. Case A 42 G3P3yo BF presents to your office c/o menorrhagia for the past year. She states that she has been using a box of tampons and pads every other day. She is having to wake up multiple times at night to change her pad to prevent soiling of her linens. She misses work occasionally and is now c/o of weakness and fatigue. Her medical history is significant for obesity, and DM which is controlled on metformin. Her sister had a hysterectomy for similar problems. Differential? Workup?

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