Abnormal Uterine Bleeding

Question 1

What is AUB?

Answer 1

Abnormal Uterine Bleeding (AUB) is a broad term that describes irregularities in the menstrual cycle involving the parameters of frequency, regularity, duration, and volume of flow outside ofpregnancy in reproductive-aged women.

Question 2

Normal menstrual cycle?

Answer 2

has a frequency of 21 to 35 days and lasts 2 to 7 days, with 5 to 80 mL of blood loss.

Question 3

What is heavy menstrual bleeding?

Answer 3

Bleeding >80 mL or heavy enough to interfere with a patient’s qualify of life

Question 4

What is intermenstrual bleeding?

Answer 4

Cyclical or random spontaneous bleeding between menstrual periods

Question 5

Breakthrough bleeding?

Answer 5

Due to hormone medication

Question 6

Approach to history in AUB?

Answer 6

Age of patient
Presenting complaint
Onset of presentation
What exactly is the abnormality (frequency, duration or volume)
Age of menarche/menopause
Last Normal Menstrual Period
Menstrual bleeding pattern
Pain (severity and treatment)
Medical conditions
Family history
Surgical history
Use of medications ( Hormonal contraception, etc.)
Pain at the back of the head
Symptoms of possible hemostatic disorder (easy bruising/bleeding)

Question 7

Approach to exam in AUB?

Answer 7

1. Vital signs: Blood pressure, pulse rate, oxygen saturations, body mass index
2. General: Nutritional status, Clinical features of anemia, Stigmata of polycystic ovarian syndrome
3. Full Abdominal exam
4. Pelvic: External genitalia inspection, Speculum, Bimanual examination
   > External genitalia –pubic hair distribution
   > Speculum – Confirm if blood is coming from the os, fresh blood, clots
   > Bimanual – Cervical motion tenderness, masses

Question 8

Investigations in AUB?

Answer 8

1. Others: Pregnancy test
2. Blood tests: Full blood count, coagulation studies, thyroid function tests, serum prolactin, serum androgen-testosterone (T) and dihydrotestosterone (DHT)
3. Imaging: Pelvic ultrasound scan
4. Histology: Hysteroscopy, endometrial biopsy (all women > 40 years with endometrial thickening)

Question 9

Management of AUB?

Answer 9

The primary goal is to control active bleeding and restore a regular menstrual cycle in select patients.
1. Immediate:
- Ensure ABCs (Airway, Breathing, Circulation).
- Resuscitate as needed, including fluid resuscitation, blood transfusion
2. Medical:
- Hormonal therapy, GnRH agonists, tranexamic acid, iron supplements, and analgesics if necessary.
3. Surgical:
- Hysteroscopic endometrial ablation, hysterectomy, uterine artery embolization, or Dilation and Curettage (D&C).

Question 10

FIGO Classification of causes of AUB?

Answer 10

PALM COEIN

Question 11

Structural causes of AUB?

Answer 11

Polyps
Adenomyosis
Leiomyoma
Malignancy & hyperplasia

Question 12

Non-structural causes of AUB?

Answer 12

Coagulopathy
Ovulatory dysfunction
Endometrial
Iatrogenic
Not yet classified