••• Chapter 24^ Functional and Dysfunctional Uterine Bleeding^243
❍ What are the usual causes of abnormal genital bleeding in postmenopausal women?
Atrophy, cancer, and estrogen replacement therapy.
❍ What percentage of adolescents that require hospitalization for abnormal bleeding have an underlying
coagulation disorder?
Approximately 25%. The majority of these patients will have von Willebrand disease, problems with platelet
count, or problems with platelet function.
❍ A 37-year-old woman, G2 P2 presents with a history of lengthening menses and acquired dysmenorrhea.
This problem had been subtly going on for 2 years and now is a quality-of-life issue. Examination reveals a
top normal size globular shaped uterus. What is the most likely diagnosis?
Adenomyosis.
❍ What is the most common cause of postmenopausal bleeding?
Atrophic endometrium and/or atrophic vaginitis.
❍ In what groups of patients other than postmenopausal women, can you find vaginal bleeding secondary to
atrophic vaginitis?
Premenarchal girls, postpartum lactating women, and women on chronic progestins.
❍ What are the most common bleeding patterns seen in a woman with cervical cancer?
Intermenstrual and postcoital bleeding.
❍ What is the size of the normal uterus?
7.5 to 9.5 cm in length (cervix to fundus), 4.5 to 6.5 cm in width (from cornua to cornua), and 2.5 to 3.5 cm
in anteroposterior diameter. Uterine cavity averages 3.5 cm in length.
❍ What is the normal thickness of the myometrium?
1 to 2 cm.
❍ What is the volume of a normal endometrial cavity in a woman of reproductive age?
7 to 10 mL.
❍ How much blood blow does the nonpregnant uterus receive?
Approximately 50 cc/min (as opposed to approximately 600 cc/min in the pregnant uterus).
❍ When in the cycle should an endometrial biopsy be performed?
At or beyond day 18, because if it shows secretory endometrium, then it confirms that ovulation has occurred
in that cycle.
❍ When should ultrasound be performed on premenopausal women for endometrium evaluation?
Days 4 and 6, when endometrium is expected to be the thinnest.