ACOG Practice Bulletins Questions and
Answers (100% Correct Answers) Already
Graded A+
When is endometrial evaluation indicated in women 13-18
years of age with AUB-O? [ Ans: ] Endometrial cancer is
rare in <20 yo women; if it occurs, it usually presents with
2-3 years of abnormal bleeding and obesity. Evaluation is
needed when medical treatment has failed after thorough
investigation
When is endometrial evaluation indicated in women 19-39
years of age with AUB-O? [ Ans: ] risk of endometrial
cancer in 20-34 is 1.6%
risk in 35-44 is 6.2%
assessment is needed in women who do not respond to
medical therapy or have prolonged periods of unopposed
estrogen
if biopsy is non-diagnostic, hysteroscopy or saline
sonohysterscope may be warranted
what are the risk factors for endometrial cancer in women
<40 years old? [ Ans: ] nulliparity
hypertension
BMI >30
,irregular menstruation
family history
When is endometrial evaluation indicated in women 40+
years of age with AUB-O? [ Ans: ] between 40-50, incidence
is 13-24/100,000
between 70-74, incidence is 87/100,000
Better prognosis in women less than 45 yo
therefore women 45+ with suspected anovulatory uterine
bleeding should received endometrial biopsy
in women with AUB-O, what is the treatment approach to
guide therapy? [ Ans: ] Exogenous steroids
1. progestin only - levonogestrel IUD,
medroxyprogesterone acetate, megestrol acetate,
norethindrone acetate, depot medroxyprogesterone
acetate
2. combined hormonal contraception
both will help thin endometrium and protect from
hyperplastic transition; combined also induce regular
withdrawal bleeding when taken cyclically
What are examples of progestin only medications? [ Ans: ]
progestin only - levonogestrel IUD, medroxyprogesterone
,acetate, megestrol acetate, norethindrone acetate, depot
medroxyprogesterone acetate
what medical therapies are most appropriate for AUB-O in
13-18 yo age range? [ Ans: ] 1. exogenous steroids
2. if clinically symptomatic or hemodynamically unstable -
-> ADMIT
3. can also prolong the interval of menstruation by
skipping the placebo week, allowing anemia to resolve
4. combined hormonal contraceptives also have the added
benefit of increased factor VIII and VWD levels, therefore
combating coagulopathy
what medical therapies are most appropriate for AUB-O in
19-40 yo age range? [ Ans: ] 1. low dose combined
hormonal contraceptives or
2. progestin only
3. weight loss and exercise for obese, anovulatory women
what medical therapies are most appropriate for AUB-O in
40+ yo age range?` [ Ans: ] in Late perimenopausal
women, cyclic progestin therapy, low dose oral
contraceptives, levonorgestrel IUD or cyclic hormone
therapy
It was found that perimenopausal symptoms were better
managed with cyclic hormone therapy
, whats are the added benefit for younger patients who
have a coagulopathy and AUB-O who take combined oral
contraceptives? [ Ans: ] combined hormonal
contraceptives also have the added benefit of increased
factor VIII and VWD levels, therefore combating
coagulopathy
whats are the added benefit for younger patients who
have PCOS and AUB-O who take combined oral
contraceptives? [ Ans: ] combined oral contraceptives
suppress ovarian and adrenal androgen production and
increase hormone binding globulin, therefore decreasing
androgens which in turn improve symptoms of hirsuitism
and acne in PCOS
In patients with AUB-O who have completed childbearing,
what are the potential concerns of endometrial ablation
treatment? [ Ans: ] - risk for endometrial cancer
- impeded future evaluation
- postablation asherman, cervical stenosis, endometrial
distortion, strictures, synechiae
what is the suggested further investigation of women with
AUB-O who have failed medical management? [ Ans: ] 1.
hysteroscopy
2. TVUS (in pre-menopausal women, should be conducted
when endometrium is thinnest at days 4-6)
Answers (100% Correct Answers) Already
Graded A+
When is endometrial evaluation indicated in women 13-18
years of age with AUB-O? [ Ans: ] Endometrial cancer is
rare in <20 yo women; if it occurs, it usually presents with
2-3 years of abnormal bleeding and obesity. Evaluation is
needed when medical treatment has failed after thorough
investigation
When is endometrial evaluation indicated in women 19-39
years of age with AUB-O? [ Ans: ] risk of endometrial
cancer in 20-34 is 1.6%
risk in 35-44 is 6.2%
assessment is needed in women who do not respond to
medical therapy or have prolonged periods of unopposed
estrogen
if biopsy is non-diagnostic, hysteroscopy or saline
sonohysterscope may be warranted
what are the risk factors for endometrial cancer in women
<40 years old? [ Ans: ] nulliparity
hypertension
BMI >30
,irregular menstruation
family history
When is endometrial evaluation indicated in women 40+
years of age with AUB-O? [ Ans: ] between 40-50, incidence
is 13-24/100,000
between 70-74, incidence is 87/100,000
Better prognosis in women less than 45 yo
therefore women 45+ with suspected anovulatory uterine
bleeding should received endometrial biopsy
in women with AUB-O, what is the treatment approach to
guide therapy? [ Ans: ] Exogenous steroids
1. progestin only - levonogestrel IUD,
medroxyprogesterone acetate, megestrol acetate,
norethindrone acetate, depot medroxyprogesterone
acetate
2. combined hormonal contraception
both will help thin endometrium and protect from
hyperplastic transition; combined also induce regular
withdrawal bleeding when taken cyclically
What are examples of progestin only medications? [ Ans: ]
progestin only - levonogestrel IUD, medroxyprogesterone
,acetate, megestrol acetate, norethindrone acetate, depot
medroxyprogesterone acetate
what medical therapies are most appropriate for AUB-O in
13-18 yo age range? [ Ans: ] 1. exogenous steroids
2. if clinically symptomatic or hemodynamically unstable -
-> ADMIT
3. can also prolong the interval of menstruation by
skipping the placebo week, allowing anemia to resolve
4. combined hormonal contraceptives also have the added
benefit of increased factor VIII and VWD levels, therefore
combating coagulopathy
what medical therapies are most appropriate for AUB-O in
19-40 yo age range? [ Ans: ] 1. low dose combined
hormonal contraceptives or
2. progestin only
3. weight loss and exercise for obese, anovulatory women
what medical therapies are most appropriate for AUB-O in
40+ yo age range?` [ Ans: ] in Late perimenopausal
women, cyclic progestin therapy, low dose oral
contraceptives, levonorgestrel IUD or cyclic hormone
therapy
It was found that perimenopausal symptoms were better
managed with cyclic hormone therapy
, whats are the added benefit for younger patients who
have a coagulopathy and AUB-O who take combined oral
contraceptives? [ Ans: ] combined hormonal
contraceptives also have the added benefit of increased
factor VIII and VWD levels, therefore combating
coagulopathy
whats are the added benefit for younger patients who
have PCOS and AUB-O who take combined oral
contraceptives? [ Ans: ] combined oral contraceptives
suppress ovarian and adrenal androgen production and
increase hormone binding globulin, therefore decreasing
androgens which in turn improve symptoms of hirsuitism
and acne in PCOS
In patients with AUB-O who have completed childbearing,
what are the potential concerns of endometrial ablation
treatment? [ Ans: ] - risk for endometrial cancer
- impeded future evaluation
- postablation asherman, cervical stenosis, endometrial
distortion, strictures, synechiae
what is the suggested further investigation of women with
AUB-O who have failed medical management? [ Ans: ] 1.
hysteroscopy
2. TVUS (in pre-menopausal women, should be conducted
when endometrium is thinnest at days 4-6)
