Evaluation of abnormal uterine bleeding

Abnormal uterine bleeding (AUB) is any symptomatic variation from normal menstruation in terms of regularity, frequency, volume, or duration.[1]Munro MG, Critchley HOD, 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. https://doi.org/10.1016/j.ijgo.2010.11.011 http://www.ncbi.nlm.nih.gov/pubmed/21345435?tool=bestpractice.com It may be acute, chronic, or intermenstrual. 

AUB affects up to 30% of women of reproductive age.[2]Shapley M, Jordan K, Croft PR. An epidemiological survey of symptoms of menstrual loss in the community. Br J Gen Pract. 2004 May;54(502):359-63. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1266170 http://www.ncbi.nlm.nih.gov/pubmed/15113519?tool=bestpractice.com

Causes include leiomyomata (fibroids), adenomyosis, endocervical and endometrial polyps, malignancy, endometrial hyperplasia, ovulatory or endometrial dysfunction, coagulopathy, and iatrogenic causes.

Initial evaluation includes a medical, surgical, and gynecological history, and pelvic examination.[3]Wouk N, Helton M. Abnormal uterine bleeding in premenopausal women. Am Fam Physician. 2019 Apr 1;99(7):435-43. https://www.aafp.org/afp/2019/0401/p435.html http://www.ncbi.nlm.nih.gov/pubmed/30932448?tool=bestpractice.com Further investigations may include blood tests and ultrasound.