Abnormal uterine bleeding

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Última revisão das evidências: 11 Mar 2026

Última atualização do tópico: 14 Nov 2025

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); symptoms can be acute or chronic.

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 toward 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 woman's age, parity, co-morbidities, need for uterine and fertility preservation, and personal preference.

Definição

Abnormal uterine bleeding (AUB) is the term used to describe any symptomatic variation from normal menstruation in terms of regularity, frequency, volume, or duration. AUB also includes symptoms of heavy menstrual bleeding and intermenstrual bleeding (IMB).[1][2] Symptoms of AUB can be either acute (an episode of heavy bleeding of a sufficient volume to require immediate intervention to prevent further blood loss) or chronic (present for more than 6 months), and acute AUB can occur on a background of chronic AUB.

História e exame físico

Principais fatores diagnósticos

uterine bleeding

Detalhes completos

Outros fatores diagnósticos

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

Detalhes completos

Fatores de risco

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

Detalhes completos

Investigações diagnósticas

Primeiras investigações a serem solicitadas

pregnancy test
CBC

Detalhes completos

Investigações a serem consideradas

coagulation profile
serum TSH level
ultrasound scan
hysteroscopy
endometrial biopsy

Detalhes completos

Algoritmo de tratamento

Inicial

emergency management of excessive uterine bleeding

AGUDA

anovulatory AUB: progestogens and estrogens not contraindicated

anovulatory AUB: progestogens and estrogens contraindicated

CONTÍNUA

significant uterine bleeding resistant to medical treatment; desiring future fertility

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

Colaboradores

Autores

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

Declarações

JG is a clinical advisor for Femcare UK.

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

Senior Clinical Fellow

Department of Reproductive Medicine

St. Mary’s Hospital

Manchester

Declarações

AS declares that she has no competing interests.

Rohan Chodankar, MBBS, MD, MRCOG

ST6 Obstetrics and Gynaecology

Royal Infirmary of Edinburgh

Scotland

Declarações

RC is supported as a Clinical Research Fellow by Bayer AG; RC is an author of references cited in this topic.

Agradecimentos

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.

Declarações

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.

Revisores

Janet Albers, MD

Associate Professor

Department of Family and Community Medicine

Southern Illinois University School of Medicine

Springfield

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

Disclosures

SS declares that she has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

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. Abstract

National Institute for Health and Care Excellence. Heavy menstrual bleeding: assessment and management. May 2021 [internet publication].Full text

American College of Obstetricians and Gynecologists. ACOG practice bulletin no. 128: diagnosis of abnormal uterine bleeding in reproductive-aged women. Jul 2012 [internet publication].Full text

American College of Obstetricians and Gynecologists. ACOG committee opinion no. 557: management of acute abnormal uterine bleeding in nonpregnant reproductive-aged women. Apr 2013 [internet publication].Full text

American College of Obstetricians and Gynecologists. Practice bulletin no. 136: management of abnormal uterine bleeding associated with ovulatory dysfunction. Jul 2013 [internet publication].Full text

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Differentials
- Pregnancy-related bleeding
- Menstrual-related migraine
- Genital lesions
More Differentials
Guidelines
- General approaches to medical management of menstrual suppression
- Heavy menstrual bleeding: assessment and management
More Guidelines
Patient information
Heavy periods
More Patient information
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Abnormal uterine bleeding

Resumo

Definição

História e exame físico

Principais fatores diagnósticos

Outros fatores diagnósticos

Fatores de risco

Investigações diagnósticas

Primeiras investigações a serem solicitadas

Investigações a serem consideradas

Algoritmo de tratamento

emergency management of excessive uterine bleeding

anovulatory AUB: progestogens and estrogens not contraindicated

anovulatory AUB: progestogens and estrogens contraindicated

significant uterine bleeding resistant to medical treatment; desiring future fertility

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

Colaboradores

Autores

Janesh Gupta, MSc, MD, FRCOG

Declarações

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

Declarações

Rohan Chodankar, MBBS, MD, MRCOG

Declarações

Agradecimentos

Declarações

Revisores

Janet Albers, MD

Disclosures

Sarina Schrager, MD, MS

Disclosures

Peer reviewer acknowledgements

Disclosures

References

Key articles

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Differentials

Guidelines

Patient information

Log in or subscribe to access all of BMJ Best Practice

Log in or subscribe to access all of BMJ Best Practice

Log in to access all of BMJ Best Practice