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Questions and Answers
Menorrhagia refers to irregular uterine bleeding
False
The PALM-COEIN system is used to classify causes of abnormal uterine bleeding
True
The normal duration of a menstrual cycle is 21-35 days
False
Uterine fibroids can only be diagnosed through imaging techniques such as transvaginal ultrasound and MRI
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Endometrial sampling is required for all women with prolonged metrorrhagia
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The management of abnormal uterine bleeding is tailored to the underlying cause
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Differential diagnosis for irregular menstrual bleeding includes categories under PALM-COEIN
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Postmenopausal vaginal bleeding occurs before 12 months of amenorrhea.
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Heavy menstrual bleeding is defined as bleeding lasting more than 7 days and exceeding 80 mL.
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Abnormal Uterine Bleeding can be classified into PALM (structural causes) and COEIN (non-structural causes).
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Postmenopausal vaginal bleeding occurs before 12 months of amenorrhea.
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Heavy menstrual bleeding is defined as bleeding lasting more than 7 days and exceeding 80 mL.
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Abnormal Uterine Bleeding can be classified into PALM (structural causes) and COEIN (non-structural causes).
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Study Notes
Uterine Fibroids and Abnormal Uterine Bleeding
- Uterine fibroids are usually diagnosed clinically and confirmed through imaging techniques such as transvaginal ultrasound and MRI
- Risk factors for uterine fibroids include early menarche, family history, and ethnicity (Caucasian and African American women)
- Symptoms of uterine fibroids depend on size and location, and may include heavy bleeding, pain, anemia, infertility, dyspareunia, and pelvic pressure
- Treatment options for uterine fibroids include expectant management, medical therapy (hormonal and non-hormonal), surgical interventions, and uterine fibroid embolization
- Common causes of irregular menstrual bleeding are categorized under PALM-COEIN (Polyp, Leiomyoma, Malignancy, Iatrogenic, Ovulatory dysfunction, Endometrial, and others, Not yet classified)
- Evaluation of irregular menstrual bleeding involves a detailed history, physical examination, laboratory tests (including hematocrit, thyroid stimulating hormone, prolactin levels, and serum FSH levels), and imaging studies
- Endometrial sampling is required for women over 35 with prolonged metrorrhagia
- Therapeutic options for irregular menstrual bleeding may include Mirena IUD, hysteroscopic ablation, combined oral contraceptive pills, and luteal phase progesterone
- Management options for irregular menstrual bleeding may include endometrial ablation techniques such as cryoablation, Novasure, balloon ablation, and hydrothermablation
- Iatrogenic causes of abnormal uterine bleeding can be due to disruption of the HPO axis, anovulation, perimenopause, thyroid disease, elevated prolactin, or stress
- The management of abnormal uterine bleeding is tailored to the underlying cause, and may involve addressing hormonal imbalances, using contraceptive methods, or performing endometrial ablation procedures
- Differential diagnosis for irregular menstrual bleeding includes PALM-COEIN categories, and appropriate labs or tests are needed to confirm the diagnosis
- The next management step for patients with abnormal uterine bleeding depends on the underlying cause and may involve hormonal therapy, IUD placement, or surgical interventions
Abnormal Uterine Bleeding: Causes and Presentation
- Postmenopausal vaginal bleeding occurs after 12 months of amenorrhea
- Acute vaginal bleeding is a heavy episode requiring immediate intervention
- Abnormal Uterine Bleeding (AUB) is defined by irregularity, volume, frequency, or duration
- Terms associated with AUB include heavy menstrual bleeding, irregular bleeding, menometrorrhagia, and frequent menstrual bleeding
- PALM-COEIN classification categorizes AUB as related or not related to structural abnormalities
- PALM includes structural causes such as polyp, adenomyosis, leiomyoma, and malignancy
- COEIN includes non-structural causes such as coagulopathy, ovulatory dysfunction, endometrial, and iatrogenic
- Coagulopathy affects around 10% of women with heavy menstrual bleeding and is often linked to Von Willebrand's disease
- Ovulatory causes of AUB involve irregular menstrual periods and can be due to endocrinopathies, mental stress, or extreme exercise
- Endometrial causes of AUB are less common and can include deficiencies in endometrial repair mechanisms or infections
- Iatrogenic causes of AUB can result from hormonal therapies, intrauterine devices, anticonvulsants, antibiotics, and medications impacting dopamine metabolism
- The etiology of abnormal bleeding varies with patient age, with different causes for younger, reproductive, and older women
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Description
Test your knowledge of uterine fibroids and abnormal uterine bleeding with this quiz. Explore risk factors, symptoms, diagnosis, and treatment options for uterine fibroids, as well as causes, evaluation, and management strategies for irregular menstrual bleeding.
