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Abnormal Uterine Bleeding
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Abnormal Uterine Bleeding
Abnormal Uterine Bleeding
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1
Question
What is frequent bleeding?
Answer
Menstruation that occurs with <24 days in between.
2
Question
What is infrequent bleeding (oligomenorrhea)?
Answer
Menstruation that occurs with >38 days in between.
3
Question
What is amenorrhea?
Answer
Lack of menstrual bleeding for 90 days.
4
Question
What defines irregular menstrual cycles?
Answer
Menstrual cycle durations that vary by ≥10 days.
5
Question
What are the characteristics of normal menstruation?
Answer
Volume: 5-80 mL; Duration: ≤ 8 days; Frequency: 24-38 days; Regularity: ≤ 7-9 days.
6
Question
What are the abnormal volumes of menstruation?
Answer
Light (< 5 mL) or Copious (> 80 mL).
7
Question
What is the abnormal duration of menstruation?
Answer
Prolonged (> 8 days).
8
Question
What are the abnormal frequencies of menstruation?
Answer
Frequent (< 24 days) or Infrequent (> 38 days), or Amenorrhea (> 90 days).
9
Question
What is the abnormal regularity of menstruation?
Answer
Irregular (≥10 days).
10
Question
What is intermenstrual bleeding?
Answer
The bleeding, usually brief, that occurs between fairly normal menstruations.
11
Question
What is the technique used to objectively measure menstrual blood loss?
Answer
Extraction of hemoglobin from sanitary towels using sodium hydroxide, converting it to hematin, and measuring it via spectrophotometry.
12
Question
What is the subjective method of assessing menstrual blood loss?
Answer
Estimating the number and type of sanitary towels or tampons a woman uses during menstruation, along with assessing blood clot expulsion.
13
Question
What is the pictorial blood assessment chart (PBAC)?
Answer
A scoring system where patients record the number of sanitary products used and their saturation level, with points assigned accordingly.
14
Question
What factors can cause the true rates of abnormal uterine bleeding in the population to vary?
Answer
Subjective self-report or objective measurement of blood loss, and differing definitions.
15
Question
What factors most influence the incidence of abnormal uterine bleeding and can help prioritize potential causes?
Answer
Age and reproductive status.
16
Question
What does the PALM-COEIN acronym stand for?
Answer
Pólipo, Adenomiosis, Leiomioma, Malignidad e hiperplasia, Coagulopatía, Trastornos ovulatorios, Disfunción endometrial, Iatrogénica, No clasificadas de otro modo.
17
Question
What does the grouping of letters in PALM-COEIN represent?
Answer
Structural and non-structural causes of abnormal uterine bleeding.
18
Question
What are the structural causes of abnormal uterine bleeding?
Answer
Pólipos, adenomiosis, leiomiomas, neoplasia intraepitelial cervical, neoplasia intraepitelial endometrial, cancer.
19
Question
What are the non-structural causes of abnormal uterine bleeding?
Answer
Coagulopatía, ovulatory disorders, endometrial dysfunction, iatrogenic causes, not otherwise specified.
20
Question
Besides uterine bleeding, what other bleeding should be considered in a differential diagnosis?
Answer
Pregnancy, neoplasia, trauma, partial obstruction of the outlet, or others such as post-surgical granulation tissue or vaginal adenosis.
21
Question
What is the diagnostic goal with abnormal uterine bleeding?
Answer
Exclusion of pregnancy or cancer and identification of the underlying disease to allow optimal treatment.
22
Question
What are the key components of an initial patient interview for abnormal uterine bleeding?
Answer
Menstrual history, associated symptoms, family history, and medication review.
23
Question
What associated symptoms may direct the evaluation of abnormal uterine bleeding?
Answer
Fever, fatigue, symptoms related to abnormal volume, expulsion of tissue, or pain.
24
Question
What medications are important to review because they can be associated with abnormal bleeding?
Answer
NSAIDs, anticoagulants, and drugs with hyperprolactinemia as a potential side effect.
25
Question
What herbal supplements have been implicated in affecting coagulation?
Answer
Ginseng, garlic, ginkgo, dong quai, and St. John's Wort.
26
Question
What is the primary goal of the gynecological exam in the context of abnormal uterine bleeding?
Answer
Confirm the site of bleeding as uterine, as vaginal, rectal, or urethral bleeding can present similarly.
27
Question
What are the tools primarily used for diagnosis of abnormal uterine bleeding?
Answer
Blood tests, cervical cytology, ultrasound (with or without saline infusion), endometrial biopsy, and hysteroscopy.
28
Question
What laboratory test should be performed on all women of child bearing age with a uterus?
Answer
β-hCG.
29
Question
What laboratory test is performed to assess for anemia, the degree of blood loss, and extremes of the platelet count?
Answer
CBC.
30
Question
What will the red blood cell indices reflect with chronic blood loss?
Answer
Microcytic, hypochromic anemia, showing declines in MCV, MCH, and MCHC.