Abnormal uterine bleeding

1. F/52, c.c-vaginal bleeding, menopause 1yr ago, no hormonal therapy, 가장 먼저 의심해 볼 출혈 원인은?

 - 위축성 내막염

*질출혈 원인

1) 외인성 호르몬 제제 2. 위축성 내막염, 질염 3. 자궁내막염 4. 자궁내막 또는 경부 폴립 5.자궁내막증식증

2. F/18, menometrorrhagia, menarche 14 yrs, irregular mense cycle, TVS n/s, 혈액검사 정상, 처치는?

 - 복합경구피임약으로 규칙적 월경 유도

3. F/16, c.c-vaginal bleeding, 연령 별 발생빈도로 추정하여 가장 큰 원인은?

 - 무배란

*연령별 질출혈 발생빈도

Reference- Berek&Novak's gynecology 14th ed.

4. O.Hx 0-0-0-0, F/24, abnormal vaginal bleeding, 어제 소량 이후 멎음, 가장 먼저 할 검사는?

 - 소변 beta-hCG test

*DDx of abnormal uterine bleeding

1.     Dysfunctional uterine bleeding

A.     Anovulatory

                         i.         Perimenarcheal – immature hypothalamic-pituitary-ovarian axis

                        ii.         Perimenopausal – insensitive ovarian follicles

                       iii.         Endocrinopathies – see systemic causes

                       iv.         Drugs – hypothalamic depressants, steroids

B.      Ovulatory

 

2.     Organic lesions

A.     Pregnancy-associated causes

                         i.         Implantation spotting

                        ii.         Abortion

                       iii.         Ectopic pregnancy

                       iv.         Gestational trophoblastic disease

                        v.         Postabortal or postpartum infection

B.      Anatomic uterine lesions

                         i.         Neoplasms – leiomyoma, polyp, endometrial hyperplasia, cancer

                        ii.         Atrophic endometrium

                       iii.         Infections – sexually transmitted disease, tuberculosis

                       iv.         Mechanical cuases – intrauterine device, perforation

                        v.         Arteriovenous malformation

                       vi.         Partial outflow obstruction – congenital mullerian defect, Asherman synd.

 

C.      Anatomic nonuterine lesions

                         i.         Ovarian lesions – hormonally functional neoplasm

                        ii.         Fallopian tube lesions – salpingitis, cancer

                       iii.         Cervical and vaginal lesions – cancer, polyp, infection, atrophic vaginitis, trauma,

 

3.     Systemic abnormalities

A.     Exogenous hormone administration – sex steroids, corticosteroids

B.      Coagulopathies

C.      Hepatic failure

D.     Chronic renal failure

E.      Endocrinopathies

                         i.         Hypothyroidism

                        ii.         Hyperthyroidism

                       iii.         Adrenal disorder

                       iv.         DM

                        v.         Hypothalamic-pituitary disorder

                       vi.         Polycystic ovarian syndrome

                      vii.         Obesity

5. F/17, c.c-dizziness, regular mense cycle, 300ml/mense, 10days long, 적절한 용어는?

 -menorrhagia, 월경과다

*월경 양상

Menorrhagia

           Bleeding over 7days a cycle

           Bleeding over 80cc/menses

Metrorrhagia

           Irregular bleeding, bleeding between periods

Polymenorrhea q<21days

Oligomenorrhea q>35days

6. F/23, c.c-vaginal bleeding onset 3days ago, menarche 13yrs old, cycle 40~50, pelvic exam n/s, beta-hCG WNL, Hb 7.8g/dl, LFT, PT/aPTT normal, 치료는?

 -oligomenorrhea-> dysfunctional uterine bleeding 의심, Hb 낮으므로 치료 필요함, 경구피임제로 월경 유도.

7. 다음 중 무배란성 비정상 자궁출혈을 일으키는 질환은?

 - PCOS, immature HPO axis, drugs(depressant, steroids), etc

8. 가임기 여성 비정상 질출혈 가장 흔한 원인?

 - exogenous hormone use

9. perimenopausal 질출혈의 원인은?

 - anovulation-> progesterone X-> continuous estrogen stimulation

10. Uterine myoma, abnormal vaginal bleeding 시행할 조치는?

 - endometrial biopsy -> 왜할까, leiomyoma?