Abnormal Uterine Bleeding (AUB): Introduction and Classification – Gynecology | Lecturio

[Music] hi now we’re gonna discuss abnormal uterine bleeding this is abbreviated AUB so you’ll hear me say that over and over again during the lecture abnormal uterine bleeding or a UB was traditionally called mini Rajah the research standard for mental blood loss was greater than 80 milliliters however on average women men straight about 25 to 30 milliliters Metro Raja was leading in between periods so again recall menorrhagia was heavy bleeding Metro Raja was bleeding in between your normal scheduled period poly materia is bleeding that occurs more often than every 21 days and that’s just really annoying all ago men area is when your period doesn’t come as often as it should all ago men area is less than every 35 days so as you can probably imagine the normal period is between 21 and 35 days and length between the time you bleed to the next cycle let’s talk now about a UB classification this is a newer classification and it starts with a UB au b h mb which is heavy menstrual bleeding which was formerly referred to as mini raja interventional bleeding which was formerly referred to as Metro Raja and there’s different causes so if we look at structural causes the first thing that you see in the new classification system is a u BP a UB P stands for polyp and the polyp can cause any one of you above bleeding abnormalities a UB a stands for adenomyosis which is a common cause of chronic pelvic pain and there is another lecture that you can refer to about chronic pelvic pain then there’s a UB L which is leiomyoma or fibroid as it’s traditionally called within leiomyoma or a ub l you’ll see here that you can have a sub coastal myoma which is in within the cavity and that is abbreviated AUB l sm for sub mucosal or you can have an other myoma and that’s a ub – l au for another myoma will review myomas shortly then the M under palm of the palm coin system which is the new system is malignancy or hyperplasia and this is referred to as a ub – m you may see this in a chart once you start on your clinical rotations now let’s look at non structural causes coagulopathy a UBC is one avila tori dysfunction meaning you probably have a legume in area or au bo and de metrio causes so there’s something wrong with the endometrium like endometritis this is a ube or iatrogenic a ubi which means we’re giving the patients something that causes them to have more bleeding than they normally should okay let’s now discuss some specifics about the structural causes of a UB here we have au BP as you remember that stands for polyp endometrial polyps are an overgrowth of cells that are usually benign and present with bleeding but usually they can be asymptomatic however if a patient says you know I have a history of bleeding in between periods that is interventional bleeding or metro Rajah you could consider polyps as a diagnosis well how do we diagnose polyps well the best way is to do a sailing and few sonogram and here you can see an ultrasound followed by an ultrasound with saline infusion so we actually use a catheter which we put saline through using a syringe and we’re able to actually open the walls of the uterus and see if there’s any pathology if you stuck a camera directly into the uterus you would see via hysteroscopy polyps that look like this in the last picture you can see it’s nice and pink it looks like the normal endometrium is just an overgrowth let’s talk about the risk factors for developing polyps obesity which is very common in the u.s. hypertension which goes along with obesity diabetes which also correlates with diabetes with hypertension and obesity and advancing age recall that tamoxifen usage is associated with polyp development so a lot of women who’ve had breast cancer this Estrin receptor positive will be on tamoxifen let’s now talk about adenomyosis a UVA adenomyosis was formerly turned in Demetrios as’ interna which in some ways was an interesting name because endometriosis which is covered in another lecture chronic pelvic pain is actually the presence of stroma and glandular tissue that should normally be normally being in the metrium inside the actual myometrium of the uterus classically an atom ionic uterus is large boggy globular and usually these patients suffer from chronic pelvic pain let’s now discuss abnormal uterine bleeding due to lay oh my omus this is a UBL uterine leiomyomas are also called myomas or fibroids they are usually benign and come from one single cell actually undergoing expansion into a large tumor they’re unlikely to be cancerous but less than 1% are reported to be so more than 80% of African Americans actually have leiomyomas and more than 70% of Caucasian or European descendant Americans also have glioma so they’re very very common and it actually increases as time goes on in the reproductive lifespan there are lots of detail specifics about leiomyomas and so if you’re in a rush you might want to skip through this and go on to the other causes of AUB but I’ll review this now you can see here that african-american versus Caucasian women have a three-fold increase of having fibroids the age of diagnosis in ass Americans tend to be three to five years younger and the severity that means the pain the pressure that they may be experiencing or the bleeding such as the AUB that we’re discussing as a five-fold increase fibroid growth at older ages has actually increased seven to eight fold the risk of having a myomectomy which is a surgery where we remove the fibroids is a six-fold increase and their risk of hysterectomy is a two to threefold increase so you can see here that african-americans have a higher incidence and also suffer more from fibroids here this is a pathology slide of a smooth muscles tumor which is what you would see with leiomyomas remember that most of them are benign but we still need to check the pathology to make sure that’s true this is a lovely diagram that shows where leiomyomas can occur there have been abnormal locations such as on the bow but they usually occur within the uterus their location differs by how we describe them rather we describe them differently based on their location so you can see here that a fibroid that’s inside the uterus and the lining is called a sub mucosal fibroid a fibroid that’s within the muscle of the uterus is called an intramural fibroid a fibroid that’s kind of just hanging whether it be a sub mucosal or subsea Roesel is a bit tongue culated fibroid sub serosa means it’s just under the tissue that lines the outside of the uterus depending on their location they can cause bleeding pain and pressure in the patient this is a view of a uterus at laparoscopy which is a minimally invasive surgery where we look in with a small camera usually through the belly button you can see here this uterus is distorted by the presence of fibroids this patient is likely going to be undergoing a laparoscopic myomectomy they can be open or abdominal myomectomy x’ as well or a history of scopic myomectomy let’s now move on to a UBC coagulopathy these again these next following a UB slides will be non structural causes approximately 20% of patients who are adolescent with a UB will have an underlying coagulopathy so remember on your exam to check for the presence of abnormalities in their bleeding times or potentially platelet function disorders von Willebrand disease or other coagulation factor issues usually these patients have some type of history that they will give you the initial screening though should include questions that specifically pinpoint these historical issues so you want to ask them did you have heavy menstrual bleeding since the beginning of your periods that’s referred to as menarche so if they report either a postpartum hemorrhage or asserted leading or bleeding associated with dental work that should be a clue that they may have a coagulopathy if they report one of those but two of these which is bruising over one or two times per month epistaxis switches nose bleeding one or two times a month frequent gum bleeding one or two times a month or even once a month and family history of bleeding you should be concerned so again one of the first category and two of the second category makes you think that there could be a UBC or coagulopathy let’s talk now about a UB o ovulatory anovulatory cycles result in a range of disorders amenorrhea means you have no menstrual period but you then can have a period which can be irregular and very heavy because you’re not shedding as you should every month the most common cause is due to polycystic ovarian syndrome there’s another lecture about PCOS or polycystic ovarian syndrome that you can look at to explain more let’s now review a ube endometrial this classification refers to endometrial causes of course we discuss endometritis which is very common in young who may be susceptible or have STI s let’s now review the final classification one of the final classifications which is a ubi our iatrogenic which means we have as healthcare providers have actually caused the AUB through some type of medication whether it be contraceptives that cause breakthrough bleeding or irregular bleeding with a levonorgestrel iud for the first three to six months or anticoagulants or antipsychotics chemotherapy which decreases the overall clotting ability or spironolactone which is a medication that we talked about in the hirsutism lecture or drugs related to dopamine metabolism such as antidepressants and antipsychotics [Music]

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