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Questions and Answers
What is the preferred imaging modality for evaluating abnormal uterine bleeding?
What is the preferred imaging modality for evaluating abnormal uterine bleeding?
What is the most effective long-term medical treatment for heavy menstrual bleeding?
What is the most effective long-term medical treatment for heavy menstrual bleeding?
What percentage of women of reproductive age are affected by abnormal uterine bleeding?
What percentage of women of reproductive age are affected by abnormal uterine bleeding?
What is the primary purpose of the PALM-COEIN classification system?
What is the primary purpose of the PALM-COEIN classification system?
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What is the estimated reduction in blood loss with the use of the 20-mcg-per-day formulation of the levonorgestrel-releasing intrauterine system?
What is the estimated reduction in blood loss with the use of the 20-mcg-per-day formulation of the levonorgestrel-releasing intrauterine system?
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What is the primary purpose of endometrial sampling in patients with abnormal uterine bleeding?
What is the primary purpose of endometrial sampling in patients with abnormal uterine bleeding?
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What is the indication for transvaginal ultrasonography in patients with abnormal uterine bleeding?
What is the indication for transvaginal ultrasonography in patients with abnormal uterine bleeding?
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What is the primary role of PALM in the classification of abnormal uterine bleeding?
What is the primary role of PALM in the classification of abnormal uterine bleeding?
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Study Notes
Classification of Abnormal Uterine Bleeding
- PALM refers to structural etiologies: polyp, adenomyosis, leiomyoma, malignancy, and hyperplasia
- COEIN refers to nonstructural etiologies: coagulopathy, ovulatory dysfunction, endometrial, iatrogenic, not otherwise classified
Evaluation and Diagnosis
- Detailed history and pelvic examination are necessary for evaluation
- Laboratory testing includes a pregnancy test and complete blood count
- Endometrial sampling is recommended for patients 45 years and older, and younger patients with significant history of unopposed estrogen exposure
- Transvaginal ultrasonography is the preferred imaging modality for suspected structural etiologies or persistent symptoms
Treatment Options
- Medical treatment options: oral estrogen, high-dose estrogen-progestin oral contraceptives, oral progestins, intravenous tranexamic acid
- Long-term medical treatment options: levonorgestrel-releasing intrauterine system, estrogen-progestin oral contraceptives, oral progestins, oral tranexamic acid, nonsteroidal anti-inflammatory drugs, depot medroxyprogesterone
- Surgical treatment options: hysterectomy, endometrial ablation, myomectomy, polypectomy, uterine artery embolization
Epidemiology and Impact
- Abnormal uterine bleeding affects 10% to 30% of women of reproductive age
- It negatively affects quality of life, is associated with financial loss, decreased productivity, poor health, and increased use of health care resources
Definitions and Classification
- Abnormal uterine bleeding is a symptom, not a diagnosis
- It is defined as bleeding that falls outside population-based 5th to 95th percentiles for menstrual regularity, frequency, duration, and volume
- Chronic bleeding occurs for most of the previous six months, while acute bleeding warrants immediate intervention
- Intermenstrual bleeding occurs between otherwise normal menstrual periods
Classification of Abnormal Uterine Bleeding
- PALM refers to structural etiologies: polyp, adenomyosis, leiomyoma, malignancy, and hyperplasia
- COEIN refers to nonstructural etiologies: coagulopathy, ovulatory dysfunction, endometrial, iatrogenic, not otherwise classified
Evaluation and Diagnosis
- Detailed history and pelvic examination are necessary for evaluation
- Laboratory testing includes a pregnancy test and complete blood count
- Endometrial sampling is recommended for patients 45 years and older, and younger patients with significant history of unopposed estrogen exposure
- Transvaginal ultrasonography is the preferred imaging modality for suspected structural etiologies or persistent symptoms
Treatment Options
- Medical treatment options: oral estrogen, high-dose estrogen-progestin oral contraceptives, oral progestins, intravenous tranexamic acid
- Long-term medical treatment options: levonorgestrel-releasing intrauterine system, estrogen-progestin oral contraceptives, oral progestins, oral tranexamic acid, nonsteroidal anti-inflammatory drugs, depot medroxyprogesterone
- Surgical treatment options: hysterectomy, endometrial ablation, myomectomy, polypectomy, uterine artery embolization
Epidemiology and Impact
- Abnormal uterine bleeding affects 10% to 30% of women of reproductive age
- It negatively affects quality of life, is associated with financial loss, decreased productivity, poor health, and increased use of health care resources
Definitions and Classification
- Abnormal uterine bleeding is a symptom, not a diagnosis
- It is defined as bleeding that falls outside population-based 5th to 95th percentiles for menstrual regularity, frequency, duration, and volume
- Chronic bleeding occurs for most of the previous six months, while acute bleeding warrants immediate intervention
- Intermenstrual bleeding occurs between otherwise normal menstrual periods
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Description
This quiz covers the classification of abnormal uterine bleeding, including structural and non-structural etiologies, and the evaluation and diagnosis process.
