242 Obstetrics and Gynecology Board Review •••
❍ What is the first step in the evaluation of abnormal uterine bleeding following the history and physical
examination in a woman?
Hemodynamic status.
❍ What is the next step in the evaluation of abnormal uterine bleeding following the history and physical
examination in a woman of reproductive age?
A pregnancy test.
❍ What additional laboratory studies are important in the workup of abnormal uterine bleeding?
CBC, PT/PTT, TSH, Prolactin levels, androgen levels, and testing for infection with Chlamydia and gonorrhea.
❍ What is the next step in the evaluation of a woman with abnormal uterine bleeding?
Evaluation of the endometrial cavity by hysterosalpingography (HSG), sonohysterography (SHG), or hysteroscopy.
❍ In a woman after age 30 with abnormal bleeding what should be obtained next?
Obtain a tissue biopsy. This may be in the form of endometrial biopsy or curettage.
❍ What is the advantage of curettage?
In the woman with heavy bleeding, it may be therapeutic as well as diagnostic.
❍ What is the most important diagnosis to rule out in the postmenopausal woman?
Cancer, primarily endometrial.
❍ Usual cause of abnormal genital bleeding in neonates?
Withdrawal from maternal estrogens.
❍ What are the usual causes of abnormal genital bleeding in premenarchal patients?
Foreign body, trauma including sexual abuse, infection, urethral prolapse, sarcoma botryoides, ovarian tumor, and
precocious puberty.
❍ What are the usual causes of abnormal genital bleeding in patients early after menarche?
Anovulation (hypothalamic immaturity), bleeding diathesis, stress (psychogenic, exercise induced), pregnancy, and
infection.
❍ What are the usual causes of abnormal genital bleeding in reproductive years?
Anovulation, pregnancy, cancer, polyps, fibroids, adenomyosis, infection, endocrine dysfunction (PCOS, thyroid,
pituitary adenoma), bleeding diathesis, medication related.
❍ What are the usual causes of abnormal genital bleeding in perimenopausal women?
Anovulation, polyps, fibroids, adenomyosis, and cancer.