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What is a potential indication of cervicitis, ectropion, or cervical cancer?
What is a potential indication of cervicitis, ectropion, or cervical cancer?
What is a consideration for clinicians when evaluating women with abnormal uterine bleeding?
What is a consideration for clinicians when evaluating women with abnormal uterine bleeding?
What is a characteristic of hemodynamic stability?
What is a characteristic of hemodynamic stability?
What is a potential underlying cause of abdominopelvic pain in women with abnormal uterine bleeding?
What is a potential underlying cause of abdominopelvic pain in women with abnormal uterine bleeding?
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What is a consideration for women with a family history of abnormal bleeding or a personal history of bleeding disorders?
What is a consideration for women with a family history of abnormal bleeding or a personal history of bleeding disorders?
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What is the primary goal of standard resuscitative measures in women with abnormal uterine bleeding?
What is the primary goal of standard resuscitative measures in women with abnormal uterine bleeding?
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What is the primary risk factor for endometrial cancer?
What is the primary risk factor for endometrial cancer?
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What is the most common symptom of endometrial cancer?
What is the most common symptom of endometrial cancer?
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What percentage of new diagnoses of endometrial cancer occur in patients younger than 55 years?
What percentage of new diagnoses of endometrial cancer occur in patients younger than 55 years?
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What is the most common cause of iatrogenic uterine bleeding?
What is the most common cause of iatrogenic uterine bleeding?
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What is the primary cause of primary disorders of endometrial hemostasis?
What is the primary cause of primary disorders of endometrial hemostasis?
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What is the diagnosis of endometrial cancer typically considered?
What is the diagnosis of endometrial cancer typically considered?
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What percentage of reduction in bleeding can be achieved by using oral tranexamic acid?
What percentage of reduction in bleeding can be achieved by using oral tranexamic acid?
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What is the typical pattern of bleeding in patients with uterine malignancy?
What is the typical pattern of bleeding in patients with uterine malignancy?
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What is the recommended approach for diagnosing endometrial cancer?
What is the recommended approach for diagnosing endometrial cancer?
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What is the benefit of using tranexamic acid while attempting to conceive?
What is the benefit of using tranexamic acid while attempting to conceive?
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What is the primary goal of using oral progestins in patients with ovulatory dysfunction?
What is the primary goal of using oral progestins in patients with ovulatory dysfunction?
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What is the limitation of using oral progestins in patients with ovulatory dysfunction?
What is the limitation of using oral progestins in patients with ovulatory dysfunction?
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What is the difference between oral tranexamic acid and nonsteroidal anti-inflammatory drugs?
What is the difference between oral tranexamic acid and nonsteroidal anti-inflammatory drugs?
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What is the search criteria used to evaluate the literature on abnormal uterine bleeding?
What is the search criteria used to evaluate the literature on abnormal uterine bleeding?
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What is the purpose of searching the Agency for Healthcare Research and Quality evidence reports?
What is the purpose of searching the Agency for Healthcare Research and Quality evidence reports?
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What is the benefit of using multiple sources to evaluate the literature on abnormal uterine bleeding?
What is the benefit of using multiple sources to evaluate the literature on abnormal uterine bleeding?
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What is the primary indication for pelvic imaging in patients with abnormal uterine bleeding?
What is the primary indication for pelvic imaging in patients with abnormal uterine bleeding?
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What is the first-line approach for most patients with abnormal uterine bleeding?
What is the first-line approach for most patients with abnormal uterine bleeding?
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When should hysteroscopic dilation and curettage be performed in patients with abnormal uterine bleeding?
When should hysteroscopic dilation and curettage be performed in patients with abnormal uterine bleeding?
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What is a major limitation of blind sampling in patients with abnormal uterine bleeding?
What is a major limitation of blind sampling in patients with abnormal uterine bleeding?
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What is a key factor to consider when choosing among treatment options for abnormal uterine bleeding?
What is a key factor to consider when choosing among treatment options for abnormal uterine bleeding?
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What is a potential benefit of identifying and treating the underlying cause of abnormal uterine bleeding?
What is a potential benefit of identifying and treating the underlying cause of abnormal uterine bleeding?
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What is the purpose of saline infusion sonohysterography in patients with abnormal uterine bleeding?
What is the purpose of saline infusion sonohysterography in patients with abnormal uterine bleeding?
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Why is routine use of magnetic resonance imaging discouraged in patients with abnormal uterine bleeding?
Why is routine use of magnetic resonance imaging discouraged in patients with abnormal uterine bleeding?
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What is the primary reason for inducing ovulatory cycles or administering supplemental progesterone in treating anovulatory abnormal uterine bleeding?
What is the primary reason for inducing ovulatory cycles or administering supplemental progesterone in treating anovulatory abnormal uterine bleeding?
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According to the International Federation of Gynecology and Obstetrics classification system, what should be used to characterize abnormal uterine bleeding?
According to the International Federation of Gynecology and Obstetrics classification system, what should be used to characterize abnormal uterine bleeding?
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What is the primary indication for performing an endometrial biopsy in patients with abnormal uterine bleeding?
What is the primary indication for performing an endometrial biopsy in patients with abnormal uterine bleeding?
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What is the primary reason for testing all patients with abnormal uterine bleeding for anemia?
What is the primary reason for testing all patients with abnormal uterine bleeding for anemia?
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What is the primary purpose of inducing ovulatory cycles in patients with anovulatory abnormal uterine bleeding?
What is the primary purpose of inducing ovulatory cycles in patients with anovulatory abnormal uterine bleeding?
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What is the primary consideration for clinicians when evaluating patients with abnormal uterine bleeding?
What is the primary consideration for clinicians when evaluating patients with abnormal uterine bleeding?
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What is the primary reason for performing an emergent endometrial biopsy in patients with abnormal uterine bleeding?
What is the primary reason for performing an emergent endometrial biopsy in patients with abnormal uterine bleeding?
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What is the primary purpose of testing all patients with abnormal uterine bleeding for pregnancy?
What is the primary purpose of testing all patients with abnormal uterine bleeding for pregnancy?
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What is a possible indication of hemodynamic instability in a patient with abnormal uterine bleeding?
What is a possible indication of hemodynamic instability in a patient with abnormal uterine bleeding?
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Which of the following may suggest an underlying infection in a patient with abnormal uterine bleeding?
Which of the following may suggest an underlying infection in a patient with abnormal uterine bleeding?
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What is a potential underlying cause of abnormal uterine bleeding that clinicians may underestimate?
What is a potential underlying cause of abnormal uterine bleeding that clinicians may underestimate?
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Which of the following is a crucial consideration in the evaluation of women with abnormal uterine bleeding?
Which of the following is a crucial consideration in the evaluation of women with abnormal uterine bleeding?
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What is the primary goal of standard resuscitative measures in women with abnormal uterine bleeding?
What is the primary goal of standard resuscitative measures in women with abnormal uterine bleeding?
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What is the likely underlying mechanism of primary disorders of endometrial hemostasis?
What is the likely underlying mechanism of primary disorders of endometrial hemostasis?
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What is the recommended approach for patients with uterine malignancy?
What is the recommended approach for patients with uterine malignancy?
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Which of the following is a potential underlying cause of abdominopelvic pain in women with abnormal uterine bleeding?
Which of the following is a potential underlying cause of abdominopelvic pain in women with abnormal uterine bleeding?
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What percentage of new diagnoses of endometrial cancer occur in patients younger than what age?
What percentage of new diagnoses of endometrial cancer occur in patients younger than what age?
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What is the primary risk factor for endometrial cancer?
What is the primary risk factor for endometrial cancer?
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What is the most common cause of abnormal uterine bleeding in patients with iatrogenic uterine bleeding?
What is the most common cause of abnormal uterine bleeding in patients with iatrogenic uterine bleeding?
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What is a characteristic of bleeding patterns in patients with uterine malignancy?
What is a characteristic of bleeding patterns in patients with uterine malignancy?
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What is the primary presentation of endometrial cancer?
What is the primary presentation of endometrial cancer?
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What is a common factor in primary disorders of endometrial hemostasis?
What is a common factor in primary disorders of endometrial hemostasis?
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In hemodynamically unstable patients, what is the primary goal of uterine tamponade using a Foley catheter or gauze packing?
In hemodynamically unstable patients, what is the primary goal of uterine tamponade using a Foley catheter or gauze packing?
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What is the most effective treatment for reducing heavy menstrual bleeding?
What is the most effective treatment for reducing heavy menstrual bleeding?
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Which of the following is the first-line imaging choice for evaluating abnormal uterine bleeding in most patients?
Which of the following is the first-line imaging choice for evaluating abnormal uterine bleeding in most patients?
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What is the primary benefit of using the 20-mcg-per-day formulation of the levonorgestrel-releasing intrauterine system (Mirena)?
What is the primary benefit of using the 20-mcg-per-day formulation of the levonorgestrel-releasing intrauterine system (Mirena)?
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What is the primary indication for emergency interventions in hemodynamically unstable patients with abnormal uterine bleeding?
What is the primary indication for emergency interventions in hemodynamically unstable patients with abnormal uterine bleeding?
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What is the primary role of medical therapy in treating hemodynamically stable patients with severe bleeding?
What is the primary role of medical therapy in treating hemodynamically stable patients with severe bleeding?
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What is the primary indication for performing a transvaginal ultrasonography in patients with abnormal uterine bleeding?
What is the primary indication for performing a transvaginal ultrasonography in patients with abnormal uterine bleeding?
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Which of the following medications is NOT a long-term medical therapy option for abnormal uterine bleeding?
Which of the following medications is NOT a long-term medical therapy option for abnormal uterine bleeding?
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What is the primary goal of endometrial ablation in patients with abnormal uterine bleeding?
What is the primary goal of endometrial ablation in patients with abnormal uterine bleeding?
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Which of the following conditions is NOT a potential underlying cause of abnormal uterine bleeding?
Which of the following conditions is NOT a potential underlying cause of abnormal uterine bleeding?
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What is the primary indication for performing a hysterectomy in patients with abnormal uterine bleeding?
What is the primary indication for performing a hysterectomy in patients with abnormal uterine bleeding?
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Which of the following medications is used to treat coagulopathy in patients with abnormal uterine bleeding?
Which of the following medications is used to treat coagulopathy in patients with abnormal uterine bleeding?
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What is the primary goal of using high-dose oral progestins in patients with abnormal uterine bleeding?
What is the primary goal of using high-dose oral progestins in patients with abnormal uterine bleeding?
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Which of the following is a long-term surgical option for abnormal uterine bleeding?
Which of the following is a long-term surgical option for abnormal uterine bleeding?
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What is the primary goal of medical management in patients with abnormal uterine bleeding?
What is the primary goal of medical management in patients with abnormal uterine bleeding?
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What is the effectiveness of the 20-mcg-per-day formulation of the levonorgestrel-releasing intrauterine system (Mirena) in decreasing heavy menstrual bleeding?
What is the effectiveness of the 20-mcg-per-day formulation of the levonorgestrel-releasing intrauterine system (Mirena) in decreasing heavy menstrual bleeding?
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What is the equivalent treatment option to the levonorgestrel-releasing intrauterine system in terms of bleeding outcomes and patient satisfaction?
What is the equivalent treatment option to the levonorgestrel-releasing intrauterine system in terms of bleeding outcomes and patient satisfaction?
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What is the indication for estrogen-progestin oral contraceptives in patients with abnormal uterine bleeding?
What is the indication for estrogen-progestin oral contraceptives in patients with abnormal uterine bleeding?
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What is the contraindication for surgical interventions in patients with abnormal uterine bleeding?
What is the contraindication for surgical interventions in patients with abnormal uterine bleeding?
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What is the treatment option for leiomyomas and endometrial polyps in patients with abnormal uterine bleeding?
What is the treatment option for leiomyomas and endometrial polyps in patients with abnormal uterine bleeding?
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Study Notes
Abnormal Uterine Bleeding
- Abnormal uterine bleeding is the most common symptom of endometrial cancer, with around 25% of new diagnoses occurring in patients under 55 years old.
- Long-term unopposed estrogen exposure is the primary risk factor for endometrial cancer.
Primary Disorders of Endometrial Hemostasis
- Typically occur in the setting of predictable ovulatory cycles
- Likely due to vasoconstriction disorders, inflammation, or infection
- Endometrial dysfunction is poorly understood, with no reliable diagnostic methods, and should be considered only after other causes are excluded.
Iatrogenic Causes
- Medical treatments can provoke abnormal uterine bleeding
- Hormonal contraception is the most common cause of iatrogenic uterine bleeding (breakthrough bleeding)
Diagnosis
- Historical clues such as passing blood clots or changing pads/tampons at least hourly suggest heavy menstrual bleeding
- A history of postcoital bleeding may indicate cervicitis, ectropion, or cervical cancer
- Abdominopelvic pain may suggest infection, structural lesions, or endometriosis
- Coagulopathies should be considered in women with a family history of abnormal bleeding or a personal history of abnormal bleeding
Imaging
- Indications for pelvic imaging include abnormalities palpated on bimanual examination or symptoms that persist despite initial treatment
- Transvaginal ultrasonography is the first-line approach for most patients
- Saline infusion sonohysterography is better at detecting intracavitary lesions
Management
- Multiple factors should be considered when choosing among treatment options, including the cause and acuity of the bleeding, fertility and contraceptive preferences, medical comorbidities, adverse effects, cost, and relative effectiveness
- If the underlying cause of bleeding can be identified and treated, symptoms may resolve without the need for additional intervention
- Anemia is an indication for treatment, as is bleeding that negatively affects the patient's quality of life
Treatment Options
- Inducing ovulatory cycles or administering supplemental progesterone to antagonize estrogen's proliferative effect on the endometrium
- Oral tranexamic acid (Lysteda) and nonsteroidal anti-inflammatory drugs are effective, well-tolerated, nonhormonal treatment options
- Continuous dosing of oral progestins is another effective hormonal treatment option (87% reduction), but long-term patient satisfaction is low
Abnormal Uterine Bleeding
- Abnormal uterine bleeding is the most common symptom of endometrial cancer
- The prevalence of endometrial cancer increases with age, but 1/4 of new diagnoses occur in patients younger than 55 years
- Long-term unopposed estrogen exposure is the primary risk factor for endometrial cancer
Primary Disorders of Endometrial Hemostasis
- Typically occur in the setting of predictable ovulatory cycles
- Likely due to vasoconstriction disorders, inflammation, or infection
- Endometrial dysfunction is poorly understood, with no reliable diagnostic methods
Iatrogenic Causes
- Hormonal contraception is the most common cause of iatrogenic uterine bleeding (i.e., breakthrough bleeding)
- Other medical treatments can also provoke abnormal uterine bleeding
Evaluation and Management
- Initial history or physical examination suggests acute or severe blood loss
- Transvaginal ultrasonography is the first-line imaging choice for evaluating abnormal uterine bleeding
- Levonorgestrel-releasing intrauterine system (Mirena) is more effective than other medical therapies for reducing heavy menstrual bleeding
- Hysterectomy is the most effective treatment for reducing heavy menstrual bleeding and yields a high level of patient satisfaction
Nonemergent Treatment
- Medical therapy is usually adequate for treating hemodynamically stable patients with severe bleeding
- Hysterectomy is the definitive and most effective treatment for abnormal uterine bleeding
- Endometrial ablation is a less invasive, lower-risk surgical option that is as effective as the levonorgestrel-releasing intrauterine system
- A variety of ablative techniques are available, and all are equivalent in terms of bleeding outcomes and patient satisfaction
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Description
This quiz covers the symptoms and risk factors of endometrial cancer, including abnormal uterine bleeding. It also explores primary disorders of endometrial hemostasis, including their causes and effects.
