what percentage of gyn office visits are for AUB?
33%
What’s the prevalence of AUB in women 18-50?
53/100
what is the epi of AUB?
bimodal adolescents and women greater than 40
Bleeding Patterns Slide
*Note that menorrhagia replaced with HMB
What is the FIGO classification system for AUB?
PALM - polyp, adenomyosis, leimyoma, malignancy (and hyperplasia)
COEIN - coagulopathy, ovulatory dysfunction, endometrial, iatrogenic, Not Yet Classified
What should you check for in the AUB patient first?
hemodynamic stability - hemorrhagic shock
what should you suspect first in the postmenopausal patient with AUB?
endometrial cancer
what should you suspect first in the pregnant patient with AUB?
ectopic pregnancy
What history components are important in AUB?
LMP, cycle length, duration, flow
pads used/day (*RF - 2 or more pads/hour for >2 hours)
OB Hx
Sexual Hx
Medication use (anticoags, OCP)
Identification of risk factors for endometrial cancer
What labs do you want in a woman with AUB?
B-HCG
CBC w/platelets
wet mount
GC/Chlamydia
TSH
PT/PTT
what imaging studies allow you to diagnose and treat AUB?
hysteroscopy
laproscopy
What is pelvic u/s (transvaginal and abd) best for in AUB?
uterine disorders
ovarian cysts/neoplasms
endometrial lining thickness or abnormalities
What’s the advantage of a sonohysterogram?
better visualization of endometrial lining and polyps
how do you perform an endometrial biopsy?
office-based procedure where speculum is instered and then suction catheter is psuhed through the os to obtain a sample of the endometrium
what is a hysterosalpingogram?
x-ray of uterus and fallopian tubes using fluroscopy to evaluate patency and architecture of fallopian tubes
It is diagnostic AND THERAPUETIC
what are the characteristics of endometrial polyps?
hyperplastic overgrowth of endometrial lining that projects from the endometrium
- usually <1cm
- mc in women >50 y.o.
- 95% benign (malignancy highest in post-menopausal women)
- hormonal influence (estrogen, progesterone)
what are the symptoms of endometrial polyps?
intermenstrual bleeding
post-coital bleeding
post-menopausal bleeding
what should you do with symptomatic endometrial polyps?
remove them
what should you do with asymptomatic endometrial polyps?
remove if they are >1.5 cm in diameter, or there multiple polyps, prolapsed through the cervix, infertility
what is adenomyosis?
barrier break between endometrium and myometrium, with endometrial cells invade the myometrium