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DUB (anovulation)
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?
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· Unexplained
· Anovulation (immature HPA)
· Young 👩🏻
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S/S
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Irregular bleeding / Heavy bleeding
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Dx
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R/O other causes;
· HypOthyroid (TSH)
· Hyperprolactinoma (PRO)
· Endometrial Cancer
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Tx
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When pt presents w/ Active bleeding:
1˚ Vitally STABLE: IV Estrogen OR High-dose OCP
2˚ Vitally UNSTABLE: D&C
If pt doen’t respond to regular tx: ablation / hysterectomy
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DDx of Abnormal Menstrual Bleeding:
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Enodometriosis
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· Dysmenorrhea, pelvic pain, dyspareunia
· Infertility
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Fibroids
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· Heavy menses with clots
· Constipation, urinary frequency, pelvic painfheaviness
· Enlarged uterus
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Adenomyosis
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· Dysmenorrhea, pelvic pain
· Heavy menses
· Bulky, globular & tender uterus
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Endometrial cancer/hyperplasia
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· Hx of obesity, nulliparity, or chronic anovulation
· Irregular, intermenstrual, or postmenopausal bleeding
· Small, nontender uterus
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Endometriosis
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Endometriosis
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Sx
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· Ectopic implantation of endometrial glands
· Dyspareunia
· Dysmenorrhea
· Chronic pelvic pain
· Infertility
· Dyschezia (difficulty defecation)
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PEx
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· Immobile uterus
· Cervical motion tenderness
· Adnexal mass
· Recto-vaginal septum, posterior cul-de-sac, uterosacral ligament nodules
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Dx
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Direct visualization (laparoscopy) & surgical bx
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Tx
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Medical (OCP, NSAlDs)
Surgical resection
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Adenomyosis
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Adenomyosis
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Path
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Abnormal endometrial tissue within the uterine myometrium
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RFs
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· Age >40
· Multiparity
· Prior uterine surgery (myomectomy)
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Clx
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· Dysmenorrhea
· Heavy menstrual bleeding
· Chronic pelvic pain
· Diffuse uterine enlargement (globular uterus)
· ± Uterine tenderness
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Dx
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· Clx
· MRI & US: Thickened myometrium
· Confirmation via Bx
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Tx
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Hysterectomy
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DDx
✳️
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How to diff. between adenomyosis and endometriosis?
· Both dysmenorrhea and chronic pelvic pain
· Unique endometriosis: dysparunea, infertility, pain peak BEFORE menses.
o Tenderness and nodularity in the posterior cul-de-sac.
o Fixed and immobile uterus.
o Menorrhagia is absent!
o Sometimes adnexal mass (ovarian enometrioma)
· Adenomyosis: menorrhagia. Boggy (soft, flaccid), tender, uniformly large uterus.
· Fibroids: big irregular uterus, heavy bleeding and urinary symptoms
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Fibroids
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Uterine leiomyomas (fibroids)
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S/S
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· Heavy, prolonged menses
· Pressure symptoms
· Pelvic pain
· Constipation
· Urinary frequency
· Obstetric complications
· Impaired fertility
· pregnancy loss
· Preterm labor
· Enlarged, irregular uterus
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Dx
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Ultrasound
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Tx
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· Asymptomatic: Observation
· Symptomatic: CHC, surgery
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Polyps = intermenstrual bleeding
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Medical treatment options for acute abnormal uterine bleeding
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· High-dose intravenous or oral estrogen
· High-dose combined oral contraceptive pills
· High-dose progestin pills
· Tranexamic acid
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Fast HY Review 