(19) Gambone: Abnormal uterine bleeding and Menopause (Repro Exam 1)

What is the average age of menopause? What is the average age of perimenopause? What occurs in perimenopause? Can pregnancy occur?

1. 51 (> 90% undergo by age of 55) 2. 47 (usually lasts 4-5 years) 3. changes in length of cycle (skipped periods are common) 4. yes

Hot flash: Number of women affected? Due to?

1. 85% 2. Low estrogen

Define: Polymenorrhea, menorrhagia, metrorrhagia, menometrorrhagia, dysfunctional uterine bleeding

1. Abnormally frequent menses at intervals less than 24 days 2. Excessive and/or prolonged menses (>80 mL and > 8 days) occring at normal intervals 3. Irregular bleeding 4. Heavy and irregular bleeding 5. Bleeding caused by ovulatory dysfunction

Causes of postmenopausal bleeding? Note?

1. Endometrial cancer 2. Estrogen withdrawal 3. Atrophic bleeding Note: Postmenopausal bleeding is bleeding that occurs after absence of bleeding for one year

Why do the postmenopausal sx occur? Does menopause cause major depressive disorder?

1. Estrogen deficiency 2. Menopause does not cause MDD (does cause depression, but not MDD)

What topics should be addressed during a postmenopausal counseling?

1. Hot flashes 2. Vaginal dryness 3. CHD, osteoporosis, alzhemier's, colon cancer, macular degeneration

Postmenopausal sx?

1. Hot flashes 2. Vaginal discomfort 3. Bladder sx 4. Heart disease 5. Osteoporosis

Define: Life span? Life expectancy?

1. Maximum human life. Determined by genetics. 2. How long the average person lives. Has increased due to medical and the social advantages of capitalism, where never in the history of human kind has the common person be so well off.

Dysfunctional Uterine Bleeding (DUB): How common is it? What age does it usually occur? Why does it occur?

1. One of the most common gynecologic problems 2. Mostly around menarche and perimenopause (But can occur at anytime) 3. Alterations in endometrial homeostasis: (A) Occurs at menarche due to failure of H-P axis to respond to positive feedback of estrogen (B) Occurs at perimenopause because of declining ovarian function

What are causes of premenarcheal bleeding?

1. Premature menarche 2. Hormone producing tumors (granulosa cell tumors) 3. Foreign objects in the vagina 4. Infections

Overall what are causes of abnormal uterine bleeding (AUB)?

Dysfunction in any of the following: 1. Hypothalamus: GnRH 2. Pituitary: FSH and LH 3. Ovarian cycle: Follicle and Luteal phases 4. Uterine cycle: Secretory and proliferative phases

Anovulatory bleeding (DUB): Tx

Either: 1. Estrogen and progestin (Best management) 2. Low dose OCs 3. NSAIDs (for mild to moderate sx) 4. Antifibrinolytic agents (tranexsamic acid) (somewhat more effective than NSAIDs) 5. Surgery (rarely used): D&C, ablation, hysterectomy

Ovarian failure should really be renamed to?

ovarian senescence (or maturation or fulfillment)

Postmenopausal tx of CHD?

Lifestyle: 1. Smoking cessation 2. Exercise 3. Healthy diet 4. Weight loss

What is ovarian "failure"?

Menopause. 3-5 year time called climacteric.

What can cause abnormal uterine bleeding? (PALM-COEIN classification)

PALM COEIN: 1. Polyp 2. Adenomyosis 3. Leiomyoma (Fibroid) 4. Malignancy 5. Coagulopathy 6. Ovulatory dysfunction 7. Endometrial 8. Iatrogenic 9. Not yet classified

In what phase of the uterine cycle does dysfunctional uterine bleeding (DUB) usually occur?

Proliferative (Anovulatory or oligo-ovulatory cycles-- PCOS)

Is postmenopausal hormone therapy widely accepted or controversial?

controversial

Perimenopause: Sx triad?

Blood (irregular menses), sweat (hot flashes) and tears (psychological disturbances)

How do you Dx DUB? Note?

By exclusion (Mnemonic for other causes of bleeding: IDSTO DUB) (ID the source of bleeding to a Dx of DUB): 1. Iatrogenic 2. Dyscrasias 3. Systemic disorders 4. Trauma 5. Organic (Tumor, infection, pregnancy) Note: Rule out pregnancy first. Also rule out vaginal, rectal, or urinary sources of bleeding.