NM701 EXAM 6 QUESTIONS AND ANSWERS WITH COMPLETE
SOLUTIONS VERIFIED LATEST UPDATE
What does PALM represent
Objective, structural causes of AUB
Polyps
Adenomyosis
Leiomyoma
Malignancy/hyperplasia
What does COEIN represent
Non-structual abnormalities which cause AUB
Coagulation
Ovulatory dysfunction
Endometrial
Iatrogenic
Not otherwise specified
AUB-C (the C in COEIN)
Coagulopathy
-20-30% of young people with HMB will have dx of von Willebrand
-h/o easy bruising, prolonged bleeding after dental work or surgery
-consider if HMB since menarche
,Dx with thorough hx and hematologic testing
-coordinate care with hematologist
Types of AUB
-Heavy menstrual bleeding (per person's report)
-Irregular cycles (unable to predict, common after menarche and during
perimenopause)
-Intermenstrual bleeding
-Prolonged bleeding (often with anovulation)
Characteristics of intermenstrual bleeding
-bleeding between periods, even if periods are irregularly timed but organized flow
-not like normal menstrual flow - spotting or light
no discernable pattern or organization = not ovulating (or doing so sporadically)
therefore, not intermenstrual
What is the cause of irregularly timed AUB? (aka lacking regular pattern)
Hormonal - HPO axis is disrupted
-thyroid
-PCOS
-endometrial hyperplasia
-hyperprolactinemia
-progestin-only contraception
-beginning and end of reproductive years (not pathologic)
,Non-HPO causes of irregular bleeding
-fibroids
-infection/endometritis
What is the cause of regularly timed AUB? (aka typical pattern but bleed is
heavier or more painful)
Structural or systemic
-fibroids
-polyps (spotting)
-blood dyscrasias (clotting abn)
Components of a thorough menstrual history
-prior pattern (what was normal length of bleed and cycle, PMS, etc)
-current pattern, if any
-intermenstrual bleeding or spotting
-rapid or gradual onset
-lifestyle or medication changes
-new symptoms that aren't menstrual
All about endometrial polyps (The P in PALM)
-asymptomatic or cause abn bleeding (intermenstrual or postmenopausal)
-most common age 30 to 50
-while generally benign, investigate bc they share similar risk factors with endometrial
cancer
, -identify with TVUS
-those discovered incidentally can be managed conservatively
All about adenomyosis (The A in PALM)
presence of endometrial cells within the myometrium
-cystic lesions more common <30 yrs old
-not clearly understood
-can cause severe/tx resistant dysmenorrhea and AUB
-Tx with LNG IUD if she wants to keep uterus
-NSAIDs to reduce pain and bleeding
-hysterectomy is curative
All about leiomyomatas aka fibroids (The L in PALM)
benign growths arising from smooth muscle of uterus
-exceedingly common
-sx: heavy or irregular bleeding, bladder and bowel pressure/change in control,
dysmenorrhea, pelvic pressure or pain, dyspareunia, infertility, pregnancy loss
-pain is typically dull or crampy, becomes acute with torsion/necrosis
-no prevention or early intervention strategies
-manage asymptomatic expectantly
-manage heavy bleeding with oral progestogens, COC, LNG-IUD, or short-term GnRH
antagonist
-surgical tx (hysterectomy, myomectomy)
Irregular menses in adolescence
irregular pattern due to HPO axis immaturity
SOLUTIONS VERIFIED LATEST UPDATE
What does PALM represent
Objective, structural causes of AUB
Polyps
Adenomyosis
Leiomyoma
Malignancy/hyperplasia
What does COEIN represent
Non-structual abnormalities which cause AUB
Coagulation
Ovulatory dysfunction
Endometrial
Iatrogenic
Not otherwise specified
AUB-C (the C in COEIN)
Coagulopathy
-20-30% of young people with HMB will have dx of von Willebrand
-h/o easy bruising, prolonged bleeding after dental work or surgery
-consider if HMB since menarche
,Dx with thorough hx and hematologic testing
-coordinate care with hematologist
Types of AUB
-Heavy menstrual bleeding (per person's report)
-Irregular cycles (unable to predict, common after menarche and during
perimenopause)
-Intermenstrual bleeding
-Prolonged bleeding (often with anovulation)
Characteristics of intermenstrual bleeding
-bleeding between periods, even if periods are irregularly timed but organized flow
-not like normal menstrual flow - spotting or light
no discernable pattern or organization = not ovulating (or doing so sporadically)
therefore, not intermenstrual
What is the cause of irregularly timed AUB? (aka lacking regular pattern)
Hormonal - HPO axis is disrupted
-thyroid
-PCOS
-endometrial hyperplasia
-hyperprolactinemia
-progestin-only contraception
-beginning and end of reproductive years (not pathologic)
,Non-HPO causes of irregular bleeding
-fibroids
-infection/endometritis
What is the cause of regularly timed AUB? (aka typical pattern but bleed is
heavier or more painful)
Structural or systemic
-fibroids
-polyps (spotting)
-blood dyscrasias (clotting abn)
Components of a thorough menstrual history
-prior pattern (what was normal length of bleed and cycle, PMS, etc)
-current pattern, if any
-intermenstrual bleeding or spotting
-rapid or gradual onset
-lifestyle or medication changes
-new symptoms that aren't menstrual
All about endometrial polyps (The P in PALM)
-asymptomatic or cause abn bleeding (intermenstrual or postmenopausal)
-most common age 30 to 50
-while generally benign, investigate bc they share similar risk factors with endometrial
cancer
, -identify with TVUS
-those discovered incidentally can be managed conservatively
All about adenomyosis (The A in PALM)
presence of endometrial cells within the myometrium
-cystic lesions more common <30 yrs old
-not clearly understood
-can cause severe/tx resistant dysmenorrhea and AUB
-Tx with LNG IUD if she wants to keep uterus
-NSAIDs to reduce pain and bleeding
-hysterectomy is curative
All about leiomyomatas aka fibroids (The L in PALM)
benign growths arising from smooth muscle of uterus
-exceedingly common
-sx: heavy or irregular bleeding, bladder and bowel pressure/change in control,
dysmenorrhea, pelvic pressure or pain, dyspareunia, infertility, pregnancy loss
-pain is typically dull or crampy, becomes acute with torsion/necrosis
-no prevention or early intervention strategies
-manage asymptomatic expectantly
-manage heavy bleeding with oral progestogens, COC, LNG-IUD, or short-term GnRH
antagonist
-surgical tx (hysterectomy, myomectomy)
Irregular menses in adolescence
irregular pattern due to HPO axis immaturity
