NR 602 NR 602 final study guide Women

602 final study guide Women’s Health Study Topics Week 5: Abnormal/Dysfunctional Uterine Bleeding AUB refers to uterine bleeding that is excessive, prolonged, or unpatterned. It can be described as follows: Polymenorrhea: Fewer than 21 days between menses Menorrhagia: Normal intervals with excessive flow or duration of menses Metrorrhagia: Irregular frequency of cycles with bleeding between cycles Menometrorrhagia: Excessive amount of bleeding with irregular frequency of cycles Treatment Mild Abnormal Uterine Bleeding A shortened cycle or menses longer than normal with flow slightly to moderately increased or unpredictable; hemoglobin greater than 12 g/dL: Observe and reassure. Have patient start and maintain a menstrual calendar. Prescribe iron supplementation and dietary interventions to prevent anemia. Use prostaglandin inhibitors to reduce heavy bleeding Common Prostaglandin Inhibitors Used to Treat Adolescent Menstrual Disorders • Ibuprofen: 400 to 800 mg TID with a loading dose of 800 mg; maximum dose of 2400 mg/24 hours • Naproxen: 500 mg at onset followed by 250 to 500 mg Q 6 to 12 hours; maximum dose of 1250 mg/24 hours • Naproxen sodium: 550 mg at onset followed by 275 mg Q 6-12 hours; maximum dose of 1375 mg/24 hours • Mefenamic acid: 500 mg at onset followed by 250 mg every 6 hours • Meclofenamate: 100 mg initially; 50 to 100 mg every 6 hours Consider OCPs for 3 to 4 months to decrease menorrhagia and stabilize menses. Reevaluate in 3 months. Moderate Abnormal Uterine Bleeding Shortened (1 to 3 weeks), irregular cycle with moderate to heavy bleeding, hemoglobin between 10 and 12 g/dL: Prescribe 30 to 35 mcg monophasic combination OCPs with a potent progestin If not currently bleeding, use same day start (see Contraception section). If currently bleeding, start with one OCP twice daily for 3 to 4 days until bleeding stops. Then continue