INSTRUCTIONS A new look at abnormal uterine bleeding
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A new look at abnormal uterine bleeding
General Purpose: The purpose of this learning activity is to provide information about abnormal uterine bleeding (AUB) and its management. Learning Objectives: After reading this article and taking the test, you should be able to: 1. Define AUB and identify its causes. 2. Identify assessment and management strategies for AUB.
- The highest incidence of AUB is in perimenopausal women and in
- adolescents just beginning to menstruate.
- prenatal women at risk for spontaneous abortion.
- women during the 6 to 12 week period after delivery.
- postmenopausal women.
- AUB is defined as
- new terminology for menorrhagia and oligomenorrhea.
- abnormally heavy bleeding related to vasodilation of the endometrium.
- abnormally heavy bleeding that occurs intermittently over at least 6 months.
- any change within normal menstruation or the normal menstrual cycle pattern.
- The PALM-COEIN classification system identifies abnormalities by bleeding pattern and
- anatomical structures.
- The patient with AUB-O has abnormal uterine bleeding caused by
- pituitary dysfunction.
- ovulatory dysfunction.
- hypothalamic dysfunction
- The normal parameter for blood loss during a menstrual cycle is defined as
- 5 to 20 ml.
- 5 to 80 ml.
- 10 to 120 ml.
- 30 to 150 ml.
- The secretory phase of the uterine cycle is under the influence of
- luteinizing hormone.
- In contrast to anovulatory bleeding, ovulatory bleeding is characterized by
- normal cervical mucus changes.
- monophasic temperature records.
- non-anatomic or functional causes.
- abnormal estradiol hormone levels.
- Endometrial polyps are
- the most common benign neoplasms.
- related to inherited coagulopathies.
- benign clumps of tissue stemming from follicles.
- pedunculated masses of stromal and endometrial glands.
- Heavy menstrual bleeding in up to a third of adolescents is frequently associated with
- endocervical polyps.
- von Willebrand disease.
- Which of the following is associated with anovulatory bleeding?
- prostaglandin surges stimulating patchwork vasodilation.
- endometrial proliferation of abnormal heights and fragility.
- abnormally low levels of plasminogen activator enzymes.
- a luteinizing hormone surge and a dysfunctional corpus luteum.
- In anovulatory bleeding, the expected serum progesterone on day 20 is
- less than 1 ng/ml.
- 1 to 3 ng/ml.
- 4 to 6 ng/ml.
- 7 to 10 ng/ml.
- The menopausal transition is associated with all of the following except
- hypothalamic-pituitary-ovarian (HPO) axis dysfunction.
- anovulatory bleeding.
- luteal out-of phase events.
- high levels of follicle development.
- Extreme exercise can cause
- ovarian dysfunction.
- platelet dysfunction.
- endometrial disorders.
- Which blood test(s) does the American College of Obstetricians and Gynecologists (ACOG) recommend in evaluating all women with AUB?
- bleeding time
- serum ferritin
- CBC with differential and thyroid stimulating hormone
- CBC with prothrombin and partial thromboplastin times
- Which diagnostic tool is not recommended as a primary tool for AUB evaluation?
- endometrial biopsy
- magnetic resonance imaging
- transvaginal ultrasonography
- saline infused sonohysterography
- The first line of treatment for a non-pregnant woman with AUB is
- single hormone therapy with estrogen.
- single hormone therapy with progestin.
- combined estrogen/progestin therapy.
- the levonogestrel intrauterine contraceptive system (LNG-IUS).
- What is the mechanism of action of LNG-IUS?
- decreases endometrial proliferation
- blocks vasodilator prostaglandins
- stabilizes the uterine fibrin matrix
- stabilizes the hypothalamus-pituitary-ovarian axis
- Women with irregular frequency or duration patterns may benefit from treatment with
- tranexamic acid.
- conjugated estrogen.