Abnormal uterine bleeding

Last reviewed: 6 Nov 2022
Last updated: 27 May 2022

Summary

Definition

History and exam

Key diagnostic factors

  • uterine bleeding
More key diagnostic factors

Other diagnostic factors

  • use of medications
  • menstrual irregularity
  • anemia
  • premenstrual molimina
  • hirsutism, acne, acanthosis nigricans
  • existing medical illness
Other diagnostic factors

Risk factors

  • women at the extremes of reproductive age (just after puberty and before menopause)
  • polycystic ovary syndrome
  • endocrine disorders
  • other anovulatory disorders
  • obesity
More risk factors

Diagnostic investigations

1st investigations to order

  • pregnancy test
  • CBC
More 1st investigations to order

Investigations to consider

  • coagulation profile
  • serum TSH level
  • ultrasound scan
  • hysteroscopy
  • endometrial biopsy
More investigations to consider

Treatment algorithm

INITIAL

emergency management of excessive uterine bleeding

ACUTE

anovulatory AUB: progestogens and estrogens not contraindicated

anovulatory AUB: progestogens and estrogens contraindicated

ONGOING

significant uterine bleeding resistant to medical treatment; desiring future fertility

significant uterine bleeding resistant to medical treatment; not desiring future fertility

Contributors

Authors

Janesh Gupta, MSc, MD, FRCOG

Professor of Obstetrics and Gynaecology

Centre for Women's and Newborn Health

Institute of Metabolism and Systems Research

University of Birmingham

Birmingham Women’s and Children’s Hospital

Birmingham

UK

Disclosures

JG has received honoraria for consultancy for Femcare-Nikomed and Bayer, and support for attending meetings and travel from Medicem. 

Akanksha Sood, MBBS, MS (OBGY), DNB, MRCOG, FACOG

Senior Clinical Fellow

Department of Reproductive Medicine

St. Mary’s Hospital

Manchester

UK

Disclosures

AS declares that she has no competing interests.

Rohan Chodankar, MBBS, MD, MRCOG

Clinical Research Fellow

MRC Centre for Reproductive Health

The Queen's Medical Research Institute

University of Edinburgh

Scotland

UK

Disclosures

RC is supported as a Clinical Research Fellow by Bayer AG; RC declares that he has no other competing interests.

Acknowledgements

Professor Gupta, Dr Sood, and Dr Chodankar would like to gratefully acknowledge Dr Mohamed Mitwally and Dr Intisar Elnahhas, the previous contributors to this topic. MM owns a patent on the use of aromatase inhibitors for endometrial thinning before hysteroscopic surgery. The patent is licensed to Meditrina Company. IE declares that she has no competing interests.

Peer reviewers

Janet Albers, MD

Associate Professor

Department of Family and Community Medicine

Southern Illinois University School of Medicine

Springfield

IL

Disclosures

JA is an author of a reference cited in this topic.

Sarina Schrager, MD, MS

Associate Professor (CHS)

Department of Family Medicine

University of Wisconsin

WI

Disclosures

SS declares that she has no competing interests.

  • Differentials

    • Pregnancy-related bleeding
    • Genital lesions
    More Differentials
  • Guidelines

    • ACR Appropriateness Criteria: abnormal vaginal bleeding
    • Heavy menstrual bleeding: assessment and management
    More Guidelines
  • Patient leaflets

    Heavy periods

    More Patient leaflets
  • padlock-lockedLog in or subscribe to access all of BMJ Best Practice

Use of this content is subject to our disclaimer