Atypical Uterine Bleeding (AUB) and General Gynaecology

Flashcards covering the terminology, etiology, evaluation, and management of Atypical Uterine Bleeding based on clinical gynaecology criteria.

Atypical Uterine Bleeding (AUB)

Any bleeding which deviates from the normal characteristics of a menstrual cycle.

PALM-COEIN Classification

A structural and non-structural classification for the etiology of AUB, encompassing Polyp, Adenomyosis, Leiomyoma, Malignancy (PALM) and Coagulopathy, Ovulatory dysfunction, Endometrial causes, Iatrogenic, and Not otherwise classified (COEIN).

Endometrial Etiology Pathogenesis

Characterized by an alteration of the $PGE_2:PGE_{2\text{a}}$ ratio and increased fibrinolytic activity with normal progesterone levels.

Anovulation Clinical Features

Includes estrogen breakthrough bleeding and irregular, heavy, painless cycles often seen in puberty or perimenopausal females.

Puberty Menorrhagia Primary Cause

The most common cause is Anovulation, followed by Coagulopathy.

Hyperprolactinemia Mechanism in AUB

Increased Prolactin provides negative feedback on GnRH, leading to decreased LH and FSH, which results in anovulation, decreased progesterone, secondary amenorrhoea, and infertility.

Dysfunctional Uterine Bleeding (DUB)

Abnormal bleeding occurring with no pelvic pathology (normal USG), no coagulopathy, and no medical or endocrine pathology.

Anovulatory DUB

Accounts for $80\%$ of cases categorized as AUB-D.

Pipelle

The worldwide instrument of choice for performing outpatient endometrial sampling, biopsy, or aspiration cytology.

Karman's cannula

The instrument commonly used in India for endometrial sampling and aspiration cytology.

Hysteroscopy Indications in AUB

Indicated for intracavitary lesions on USG, intermenstrual bleeding suggesting a polyp, or history of curettage suggesting Asherman syndrome.

Menopause Age Statistics

The average age of menopause is $47$ years in India and $51$ years worldwide.

Perimenopause Age Definitions

Defined as $>40$ years in India and $>45$ years worldwide (per ACOG).

Post-menopausal TVS Threshold

An endometrial thickness of $\ge 4\,mm$ on Transvaginal Ultrasound (TVS) necessitates an endometrial biopsy.

Tranexamic acid

An antifibrinolytic drug that reduces AUB by $50\%$; the standard dose is $1\,g$ thrice daily for $3-4$ days.

Mefenamic acid

A prostaglandin synthetase inhibitor that blocks prostaglandin receptors, indicated for AUB paired with dysmenorrhoea.

Ethamsylate

A drug used for capillary fragility that is noted to be not effective in the management of AUB.

Combined Oral Contraceptive Pills (OCPs) Mechanism

The Estrogen (E) component upregulates progesterone (P) receptors, while the Progesterone (P) component downregulates estrogen receptors on the endometrium.

Mirena

A progesterone-containing IUCD that causes endometrial atrophy and provides relief for AUB in $30-40\%$ of cases.

GnRH analogues

Drugs that decrease LH, FSH, and Estrogen on continuous administration; used for a maximum of $6$ months, often before surgery or endometrial ablation.

Ormeloxifene

A Selective Estrogen Receptor Modulator (SERM) that antagonizes the effect of estrogen on the endometrium to cause atrophy.

Puberty Menorrhagia Blood Transfusion Threshold

Indication for blood transfusion when Hemoglobin (Hb) is $<7\,g/dL$.

Endometrial Ablation

A surgical procedure destroying the endometrial lining up to $4-6\,mm$ deep, indicated after failure of medical management in patients with a completed family.

Asherman syndrome

Intrauterine adhesions that may occur following a history of curettage, often presenting with AUB symptoms.

PCOS Examination Signs

Physical indicators include Hirsutism, Acanthosis nigricans, and acne.