Abnormal uterine bleeding

A common and often debilitating condition, affecting women of reproductive age.

Abnormal uterine bleeding (AUB) is any variance of the normal menstrual cycle, which is defined on the basis of four parameters (frequency, regularity, duration, and volume).

The International Federation of Gynecology and Obstetrics PALM-COEIN classification system improves the understanding of the causes of AUB, facilitates effective history taking and examination, and allows for shared decision-making towards tailored investigations and management plans.

A range of medical and surgical management options are available, and the choice of treatment is guided by the underlying cause of AUB alongside the patient's age, parity, co-morbidities, need for uterine and fertility preservation, and personal preference.

Abnormal uterine bleeding (AUB) is the term used to describe any symptomatic variation from normal menstruation in terms of regularity, frequency, volume, or duration. It also includes inter-menstrual bleeding (IMB).[1]Munro MG, Critchley HO, Broder MS, et al. FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age. Int J Gynaecol Obstet. 2011 Apr;113(1):3-13. http://www.ncbi.nlm.nih.gov/pubmed/21345435?tool=bestpractice.com [2]Fraser IS, Critchley HO, Broder M, et al. The FIGO recommendations on terminologies and definitions for normal and abnormal uterine bleeding. Semin Reprod Med. 2011 Sep;29(5):383-90. http://www.ncbi.nlm.nih.gov/pubmed/22065325?tool=bestpractice.com This differs from dysfunctional uterine bleeding (DUB), which is diagnosed by excluding pregnancy, iatrogenic causes, systemic conditions, and genital tract pathology.[3]Speroff L, Fritz M, eds. Abnormal uterine bleeding. In: Clinical gynecologic endocrinology and infertility. 8th ed. Baltimore, MD: Lippincott Williams & Wilkins; 2010:591-620.