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Questions and Answers
Which term best describes irregular and heavy menstrual bleeding?
What is a normal range between menstrual cycles?
Which system is used to classify causes of abnormal uterine bleeding?
Which imaging techniques are used to confirm the diagnosis of uterine fibroids?
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What are the risk factors for uterine fibroids?
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What is required for women over 35 with prolonged metrorrhagia?
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What are the treatment options for uterine fibroids?
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What are the management options for irregular menstrual bleeding?
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Which of the following best describes postmenopausal vaginal bleeding?
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What is the definition of acute vaginal bleeding?
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Which of the following is included in the terminology of Abnormal Uterine Bleeding (AUB)?
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What does PALM-COEIN classify AUB as related or not related to?
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Which of the following is a COEIN cause of AUB?
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What is the most common non-structural cause of AUB?
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What do ovulatory causes of AUB involve?
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What do endometrial causes of AUB include?
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What do iatrogenic causes of AUB involve?
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What does the etiology of abnormal bleeding depend on?
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Which of the following is classified as a PALM cause of AUB?
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What is the classification of AUB as per PALM-COEIN based on?
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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
Postmenopausal Vaginal Bleeding and Abnormal Uterine Bleeding
- Postmenopausal vaginal bleeding refers to bleeding that occurs after 12 months of amenorrhea
- Acute vaginal bleeding is an episode of heavy bleeding requiring immediate intervention
- Abnormal Uterine Bleeding (AUB) is defined by irregularity, volume, frequency, or duration of bleeding
- AUB terminology includes heavy menstrual bleeding (>7 days, >80 mL), irregular menstrual bleeding, menometrorrhagia (heavy, irregular), and frequent menstrual bleeding <35 days apart
- PALM-COEIN classifies AUB as related or not related to structural abnormalities
- PALM (structural causes) of AUB include polyp, adenomyosis, leiomyoma, and malignancy
- COEIN (non-structural causes) of AUB include coagulopathy, ovulatory dysfunction, endometrial, and iatrogenic causes
- Coagulopathy, the most common non-structural cause, may be due to von Willebrand's disease, leading to very heavy periods and anemia
- Ovulatory causes of AUB include irregular menstrual periods and endocrinopathies such as hypothyroidism and polycystic ovarian syndrome
- Endometrial causes of AUB include deficiency in endometrial repair mechanisms and local production of endothelin1 and prostaglandin F2
- Iatrogenic causes of AUB involve hormonal therapies, intrauterine devices, anticonvulsants, and medications impacting dopamine metabolism
- The etiology of abnormal bleeding depends on the patient's age, with different causes for younger, reproductive, and older women
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Description
Test your knowledge on uterine fibroids, abnormal uterine bleeding, and postmenopausal vaginal bleeding with this comprehensive quiz. Explore the diagnosis, risk factors, symptoms, and management options for these conditions, as well as the PALM-COEIN classification system for abnormal uterine bleeding.
