Aralin 1Medical management ng AUB: progestins, combined hormonal therapy, tranexamic acid, levonorgestrel intrauterine system — mechanisms, dosing, contraindicationsInilalahad ang medical therapies para sa abnormal uterine bleeding, kabilang ang progestins, combined hormonal methods, tranexamic acid, at levonorgestrel intrauterine system, na may mechanisms, dosing, contraindications, at monitoring para sa adverse effects.
Mechanisms ng progestin-based regimensCombined hormonal therapy choicesPaggamit ng tranexamic acid at cautionsLevonorgestrel IUS indikasyon at insertionContraindications at drug interactionsMonitoring ng response at pag-a-adjust ng therapyAralin 2Surgical at procedural options: hysteroscopy, polypectomy, myomectomy, endometrial ablation, hysterectomy — indikasyon at perioperative considerationsInilalahad ang surgical at procedural options para sa abnormal uterine bleeding, kabilang ang hysteroscopy, polypectomy, myomectomy, endometrial ablation, at hysterectomy, na may diin sa indikasyon, contraindications, at perioperative risk assessment.
Diagnostic at operative hysteroscopyPolypectomy techniques at follow-upMyomectomy routes at patient selectionEndometrial ablation indikasyon at limitsHysterectomy approaches at counselingPerioperative optimization at consentAralin 3Endometrial sampling techniques: office endometrial biopsy, pipelle, dilation at curettage—indikasyon at interpretationInilalahad ang indikasyon, techniques, at limitations ng office endometrial sampling, kabilang ang pipelle biopsy at dilation at curettage, na may diin sa specimen adequacy, pathology terms, at kung paano i-interpret ang mga resulta sa klinikal na konteksto.
Patient selection para sa office biopsyPipelle technique at pain controlKapag pipiliin ang dilation at curettageHandling ng insufficient o failed samplesPathology ng hyperplasia at carcinomaPost-procedure counseling at follow-upAralin 4Contemporary classification ng abnormal uterine bleeding (PALM-COEIN) at pag-aaplay nito sa klinikaIpinaliliwanag ang PALM-COEIN classification ng abnormal uterine bleeding, na tinatangi ang structural mula sa nonstructural causes, at nagpapakita kung paano i-apply ang framework na ito sa history, examination, at investigations sa araw-araw na klinikal na praktis.
Overview ng PALM structural categoriesCOEIN nonstructural etiologiesMapping ng symptoms sa PALM-COEIN causesPag-integrate ng imaging at labs sa diagnosisCase examples gamit ang frameworkDocumentation at coding considerationsAralin 5First-line investigations: pregnancy test, CBC, coagulation kung indicated, transvaginal ultrasound (endometrial thickness thresholds)Tinutustos ang initial evaluation ng abnormal uterine bleeding, na binibigyang-diin ang pagwawala ng pregnancy, anemia at coagulopathy screening, at transvaginal ultrasound na may age- at risk-adjusted endometrial thickness thresholds upang gabayan ang karagdagang investigation.
Rule out pregnancy at ectopic gestationCBC, iron studies, at anemia assessmentKapag mag-order ng coagulation at platelet testsTransvaginal ultrasound technique basicsEndometrial thickness thresholds batay sa risk groupImaging findings na nangangailangan ng urgent workupAralin 6Genetic risk assessment at referral pathways para sa suspected hereditary cancer syndromes (Lynch): kriterio, appropriate genetic testing referral triggersInilalahad ang pagkilala sa hereditary endometrial cancer risk, na nakatuon sa Lynch syndrome kriterio, family history patterns, appropriate genetic testing referrals, at koordinasyon sa genetics services at high-risk surveillance programs.
Key features ng Lynch-associated cancersPaggamit ng Amsterdam at revised Bethesda kriterioRed flags sa family at personal historyKapag at paano ire-refer para sa genetic testingCounseling bago at pagkatapos ng test resultsImplications para sa relatives at cascade testingAralin 7Focused physical exam findings sa AUB at senyales na nagmumungkahi ng gynecologic malignancy (uterine enlargement, adnexal mass, abnormal discharge)Sinuri ang focused pelvic at systemic examination sa abnormal uterine bleeding, na binibigyang-diin ang mga findings na nagmumungkahi ng gynecologic malignancy, tulad ng uterine enlargement, adnexal masses, at abnormal discharge, at kung paano i-document at i-triage ang mga ito.
Structured pelvic exam sa AUBPagsusuri sa uterine size at contourEvaluation ng adnexal massesPagkarakterisa ng cervical at vaginal lesionsAbnormal discharge at odor patternsSystemic signs na nagmumungkahi ng advanced diseaseAralin 8Red flags na nangangailangan ng urgent evaluation: postmenopausal bleeding, intermenstrual bleeding na may mass, rapid uterine enlargement, systemic symptoms na nagmumungkahi ng malignancyTinutukoy ang mga bleeding patterns at associated symptoms na nangangailangan ng urgent evaluation, kabilang ang postmenopausal bleeding, intermenstrual bleeding na may mass, rapid uterine enlargement, at systemic features na nakabahala para sa underlying malignancy.
Postmenopausal bleeding assessmentIntermenstrual bleeding na may mass signsRapid uterine growth at sarcoma concernSystemic symptoms na nagmumungkahi ng malignancyEmergency imaging at lab prioritiesKriterio para sa urgent referral o admissionAralin 9Counseling sa surveillance, fertility preservation options, lifestyle modifiers, at follow-up plansTinutugunan ang counseling para sa mga pasyenteng may increased endometrial cancer risk, kabilang ang surveillance strategies, fertility preservation options, lifestyle modification, at structured follow-up plans na na-customize sa edad, comorbidities, at reproductive goals.
Pag-individualize ng surveillance intervalsFertility preservation sa high-risk patientsWeight, exercise, at metabolic controlHormonal risk reduction strategiesPagdidisenyo ng clear follow-up plansShared decision-making at documentationAralin 10Focused history at risk factor assessment para sa endometrial hyperplasia at cancer kabilang ang family history ng Lynch syndrome at breast/colon cancersNakatuon sa targeted history taking para sa abnormal uterine bleeding at endometrial cancer risk, kabilang ang menstrual patterns, metabolic factors, medication use, at detailed family history ng Lynch syndrome at related breast o colon cancers.
Pagkarakterisa ng bleeding pattern at chronicityPagsusuri sa obesity, PCOS, at diabetesHormone therapy at tamoxifen exposurePersonal history ng gynecologic pathologyFamily history ng Lynch-related cancersRisk stratification at documentation
