Practice Bulletin 128: Diagnosis of Abnormal Uterine Bleeding

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Questions and Answers

What percentage of outpatient visits to the gynecologist are attributed to abnormal uterine bleeding?

70%

10%

33% (correct)

50%

What is the normal duration of menstrual flow?

5 days (correct)

3 days

10 days

7 days

Which of the following is NOT part of the PALM–COEIN classification system?

Malignancy

Oligomenorrhea

Coagulopathy

Menorrhagia (correct)

How long does a normal menstrual cycle typically last?

21 to 35 days Signup and view all the answers

What type of bleeding does the document explicitly state it does NOT address?

Pregnancy-related bleeding Signup and view all the answers

What term is used to describe heavy menstrual bleeding?

Menorrhagia Signup and view all the answers

Which organization developed the PALM–COEIN nomenclature system?

The International Federation of Gynecology and Obstetrics Signup and view all the answers

What is a known cause of abnormal uterine bleeding?

Hormonal imbalances Signup and view all the answers

What classification system is used for understanding the causes of abnormal uterine bleeding (AUB)?

PALM-COEIN Signup and view all the answers

Which of the following is not a structural cause of abnormal uterine bleeding according to the PALM-COEIN classification?

Coagulopathy (AUB-C) Signup and view all the answers

What does the 'P' in the PALM-COEIN classification stand for?

Polyp Signup and view all the answers

Which of the following is classified under nonstructural causes of abnormal uterine bleeding?

Endometrial (AUB-E) Signup and view all the answers

What is a recommended method for evaluating abnormal uterine bleeding?

Thorough medical history and physical examination Signup and view all the answers

Which of the following conditions is specifically linked to ovulatory dysfunction in the COEIN classification?

Ovulatory dysfunction (AUB-O) Signup and view all the answers

What should be considered during the evaluation of women with abnormal uterine bleeding regarding their demographic factor?

Age-related factors Signup and view all the answers

What is the classification for bleeding that occurs between menstrual periods?

Intermenstrual bleeding (IMB) Signup and view all the answers

What imaging method is recommended when there is a risk of structural anomaly and previous medical therapy has been unsuccessful?

Magnetic Resonance Imaging (MRI) Signup and view all the answers

Which condition would warrant an endometrial biopsy based on risk factors?

Chronic ovulatory disorder Signup and view all the answers

If ultrasound indicates a normal endometrial cavity, what further evaluation is typically unnecessary?

Endometrial biopsy Signup and view all the answers

In which scenario would MRI be particularly valuable for evaluation?

In virginal girls and women where other methods are not feasible Signup and view all the answers

What does AUB-M refer to in the context of uterine evaluation?

Malignancy and hyperplasia Signup and view all the answers

When is endometrial biopsy deemed appropriate?

For patients with atypical hyperplasia Signup and view all the answers

What is a reason that may complicate evaluation by hysteroscopy?

Inconclusive results from previous assessments Signup and view all the answers

Which of the following is NOT a type of abnormal uterine bleeding indicated by the abbreviation AUB?

AUB-L (lesion) Signup and view all the answers

What is one of the imaging techniques compared with sonohysterography for detecting intracavitary pathologies?

MRI Signup and view all the answers

Which comparison was made regarding the effectiveness in women with abnormal uterine bleeding?

Hydrosonography vs. transvaginal ultrasonography Signup and view all the answers

What is the primary topic of comparison in the studies mentioned in the content?

Imaging techniques for uterine evaluations Signup and view all the answers

Which study level was assigned to the comparison of transvaginal sonography and saline infusion sonography?

Level II-3 Signup and view all the answers

In the context of imaging techniques for uterine evaluation, what does 'intracavitary pathologies' refer to?

Conditions or growths within the uterine cavity Signup and view all the answers

What advantage does 3D saline infusion sonography have over 2D saline infusion sonography?

Increased accuracy in detecting fibroids Signup and view all the answers

Which imaging modality was discussed for evaluating fibroid burden in women?

Magnetic resonance imaging Signup and view all the answers

Which imaging method is described as having a clinical value in diagnosing abnormal uterine bleeding?

Saline infusion sonography Signup and view all the answers

Which condition is classified under the PALM-COEIN system as endometrial hyperplasia or carcinoma?

AUB-M Signup and view all the answers

What is the primary pathological mechanism in ovulatory AUB?

Unopposed estrogen Signup and view all the answers

Which of the following is an inherited coagulopathy that can contribute to abnormal uterine bleeding?

Von Willebrand disease Signup and view all the answers

What percentage of women presenting with heavy menstrual bleeding may have an underlying bleeding disorder?

20% Signup and view all the answers

Which diagnostic screening should be performed if there is concern about a bleeding disorder related to AUB?

Hemostasis evaluation Signup and view all the answers

Which of the following disorders is categorized under ovulatory dysfunction causing AUB?

Polycystic ovary syndrome (PCOS) Signup and view all the answers

Which class of medications is known to potentially cause AUB?

Nonsteroidal anti-inflammatory drugs (NSAIDs) Signup and view all the answers

Which statement about ovulatory AUB is accurate?

It includes a spectrum of disorders from amenorrhea to irregular heavy periods. Signup and view all the answers

Study Notes

Abnormal Uterine Bleeding (AUB) Overview

AUB defined as menstrual flow that deviates from normal volume, duration, regularity, or frequency.
One-third of gynecologist outpatient visits are for AUB; it constitutes over 70% of gynecologic consultations in perimenopausal and postmenopausal women.

Classification of AUB

A new classification system, PALM–COEIN, categorizes AUB into structural and nonstructural causes.
Structural causes (PALM):
- Polyp (AUB-P)
- Adenomyosis (AUB-A)
- Leiomyoma (AUB-L)
- Malignancy & hyperplasia (AUB-M)
Nonstructural causes (COEIN):
- Coagulopathy (AUB-C)
- Ovulatory dysfunction (AUB-O)
- Endometrial (AUB-E)
- Iatrogenic (AUB-I)
- Not yet classified (AUB-N)

Normal Menstrual Cycle Parameters

Normal menstrual flow typically lasts 5 days.
Menstrual cycles range from 21 to 35 days.

Evaluation of AUB

Comprehensive evaluation includes medical history, physical examination, and diagnostic tests.
Key elements of medical history:
- Patterns and severity of menstrual bleeding.
- Pain associated with bleeding.
- Family history of AUB or bleeding disorders.
Conditions like von Willebrand disease and PCOS must be considered.

Diagnostic Procedures

Initial screening for underlying bleeding disorders is critical for women with heavy menstrual bleeding.
Imaging studies:
- Transvaginal ultrasound is often the first line for imaging.
- Hysteroscopy and sonohysterography may be necessary for further evaluation.

Management Guidelines

Risk factors for endometrial hyperplasia or malignancy dictate the necessity of endometrial biopsy.
Women at higher risk should undergo appropriate imaging assessments (e.g., MRI if required).
Management tailored based on the classification of AUB and individual patient factors.

Pathophysiology of AUB

Common causes of AUB include:
- Endometrial polyps (AUB-P)
- Adenomyosis (AUB-A)
- Uterine leiomyomas (AUB-L)
- Endometrial hyperplasia or carcinoma (AUB-M)
Ovulatory dysfunction (AUB-O) linked to hormonal imbalances, often due to endocrine disorders.

Clinical Recommendations

Differentiating between structural and nonstructural causes is essential for appropriate treatment.
Continued research and understanding of AUB patterns are crucial for advancing clinical practices.

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Description

This quiz covers the clinical management guidelines set forth by the American College of Obstetricians and Gynecologists regarding the diagnosis of abnormal uterine bleeding in reproductive-aged women. Participants will assess their knowledge on menstrual flow variations and associated clinical practices. Perfect for obstetricians and gynecologists looking to refresh their understanding.