Abnormal Uterine Bleeding

Question 1

Definition

Answer 1

Abnormal uterine bleeding is the medical term for abnormalities in the frequency, volume, duration, and regularity of the menstrual cycle

Question 2

Normal menstrual bleeding

Answer 2

1. Normal frequency (cycle length): ≥ 24 days to ≤ 38 days
2. Normal duration: ≤ 8 days
3. Normal flow volume: no physical, social, or emotional distress caused by flow.° Determined by patient
   ° Average flow is approximately 30 mL
4. Normal regularity: variation between shortest and longest cycles is ≤ 7–9 days (or average cycle length ± 4 days)° 18–25 and 42–45 years of age: ≤ 9 days
   ° 26–41 years of age: ≤ 7 days

Question 3

Abnormal uterine bleeding

Answer 3

1. Symptomatic abnormalities in the regularity, duration, frequency, and volume of menses.
2. Also includes intermenstrual bleeding (IMB) (bleeding between normal menses)
3. Variation may be:

° Acute AUB: bleeding in sufficient quantity that warrants immediate intervention to prevent further blood loss

° Chronic AUB: abnormalities in uterine bleeding present for most of the last 6 months

Question 4

Classification, Abnormalities in frequency:

Answer 4

Infrequent uterine bleeding:

° Menstrual interval > 38 days

° Previously called oligomenorrhea

Frequent uterine bleeding:

° Menstrual interval < 24 days

° Previously called polymenorrhea

Question 5

Classification, Abnormalities in volume:

Answer 5

1. AUB/heavy menstrual bleeding (HMB):

° Excessive menstrual blood loss (objectively defined as > 80 mL blood loss/cycle)

° Can be based on heavy flow, as determined by the patient

° Interferes with physical, social, emotional, and/or material quality of life

° Independent of cycle duration, frequency, or regularity (although abnormalities may coexist)

° Previously called menorrhagia

2. Light menstrual bleeding:

° < 5 mL blood loss/cycle

° Infrequent

° While rare, may result from cervical stenosis or intrauterine synechiae

Question 6

Classification, Abnormalities in regularity:

Answer 6

Irregular uterine bleeding:variation between shortest and longest cycles is ≥ 8‒10 days

°In some young women, long cycles evolve and eventually fit the usual variation.

Question 7

Classification, Abnormalities in duration:

Answer 7

Prolonged uterine bleeding:menses lasting > 8 days

° No consensus on lower limit: ↓ duration is not specifically related to a clinical condition, except for amenorrhea.

Question 8

Classification, Intermenstrual bleeding (IMB):

Answer 8

1. Bleeding between the cyclic, regular onset of menses that can be:

° Random

° Cyclic (early, mid, or late cycle)

2. Previously called metrorrhagia
3. Includes breakthrough bleeding (from hormone administration) and postcoital bleeding

Question 9

Classification, Absence of menstruation:

Answer 9

1. Primary amenorrhea:

° No menses by 13 years of age in the absence of secondary sex characteristics

° No menses by 15 years of age regardless of secondary sex characteristics

° Secondary sex characteristics include the development of breasts, axillary hair, and pubic hair.

2. Secondary amenorrhea:

° Absence of menses for 3 months after previouslyregularmenstrual cycles

° Absence of menses for 6 months after previouslyirregularmenstrual cycles

° Absence of menses for 3 cycle lengths (in women with infrequent menstrual bleeding)

Question 10

Causes

Answer 10

1. Structural causes

2. Non-structural causes

Question 11

Structural causes

Answer 11

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Question 12

Non-structural causes

Answer 12

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Question 13

Dysfunctional uterine bleeding (DUB

Answer 13

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