Abnormal uterine bleeding (AUB) is a common and often debilitating condition, affecting women of reproductive age.
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). This differs from dysfunctional uterine bleeding (DUB), which is diagnosed by excluding pregnancy, iatrogenic causes, systemic conditions, and genital tract pathology.
History and exam
Key diagnostic factors
- uterine bleeding
Other diagnostic factors
- use of medications
- menstrual irregularity
- premenstrual molimina
- hirsutism, acne, acanthosis nigricans
- existing medical illness
- women at the extremes of reproductive age (just after puberty and before menopause)
- polycystic ovary syndrome
- endocrine disorders
- other anovulatory disorders
1st investigations to order
- pregnancy test
Investigations to consider
- coagulation profile
- serum TSH level
- ultrasound scan
- endometrial biopsy
emergency management of excessive uterine bleeding
anovulatory AUB: progestogens and oestrogens not contraindicated
anovulatory AUB: progestogens and oestrogens contraindicated
significant uterine bleeding resistant to medical treatment; desiring future fertility
significant uterine bleeding resistant to medical treatment; not desiring future fertility
- Pregnancy-related bleeding
- Genital lesions
- Heavy menstrual bleeding: assessment and management
- ACR Appropriateness Criteria: abnormal vaginal bleeding
Heavy periodsMore Patient leaflets
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