Case Study:
You work in a women’s health clinic. Abnormal uterine bleeding (AUB) is one of the most common reasons women seek health care.
Questions to answer:
Discuss and describe the pathophysiology and symptomology/clinical manifestations of AUB.
Discuss three differential diagnoses for AUB with ICD 10 numbers for each.
Discuss patient education.
Develop the management plan (pharmacological and non-pharmacological).
An effective health assessment incorporates not only physiological parameters; please suggest other parameters that should be considered and included on health assessments to reach maximal health potential on individuals.
Name the different family developmental stages and give examples of each one.
Describe family structure and function and the relationship with health care.
Structural Causes (PALM): These include polyps (P), adenomyosis (A), leiomyomas (L), and malignancy/hyperplasia (M). These physical abnormalities can alter the endometrial blood supply, increase the surface area for bleeding, or interfere with muscular contractions that stop bleeding.
Non-structural Causes (COEIN): These relate to systemic or hormonal issues and include coagulopathy (C), ovulatory dysfunction (O), endometrial disorders (E), iatrogenic causes (I, e.g., medication side effects), and not yet classified (N). The most common non-structural cause is ovulatory dysfunction, where anovulation leads to continuous estrogen stimulation without progesterone to stabilize the endometrium, causing it to grow excessively and shed unpredictably.
Symptomology, or clinical manifestations, of AUB can include:
Menorrhagia: Abnormally heavy or prolonged menstrual bleeding.
Metrorrhagia: Irregular bleeding between menstrual periods.
Polymenorrhea: Menstrual cycles that are too frequent (less than 21 days apart).
Oligomenorrhea: Menstrual cycles that are too infrequent (more than 35 days apart).
Postmenopausal bleeding: Any vaginal bleeding after menopause, which is always considered abnormal and requires immediate investigation.
Differential Diagnoses for AUB
Uterine Fibroids (Leiomyomas): These are noncancerous growths of the uterus that can cause heavy bleeding.
ICD-10 Code: D25.9 (Leiomyoma of uterus, unspecified).
Polycystic Ovary Syndrome (PCOS): A hormonal disorder that causes ovulatory dysfunction, leading to irregular or absent periods and often AUB.
ICD-10 Code: E28.2 (Polycystic ovarian syndrome).
Endometrial Hyperplasia: An overgrowth of the uterine lining, which can be caused by unopposed estrogen and can lead to cancer if left untreated.
ICD-10 Code: N85.0 (Endometrial hyperplasia, unspecified).
Patient Education
Patient education is crucial for managing AUB. It should cover:
Understanding the Diagnosis: Explain the specific cause of AUB in a clear, easy-to-understand manner. Use diagrams or models to illustrate the condition (e.g., polyps, fibroids).
Sample Answer
Abnormal Uterine Bleeding (AUB)
Pathophysiology and Symptomology
The pathophysiology of AUB is diverse, stemming from both structural and non-structural causes, as categorized by the PALM-COEIN classification system. Normal uterine bleeding is regulated by hormonal fluctuations of estrogen and progesterone, which control the growth and shedding of the uterine lining (endometrium). AUB disrupts this hormonal balance, leading to irregular, heavy, or prolonged bleeding.