Evaluation of abnormal uterine bleeding - Summary

Diseases

Summary

Abnormal uterine bleeding (AUB) is any symptomatic variation from normal menstruation in terms of regularity, frequency, volume, or duration.[1] AUB may be further classified as acute (an episode of heavy bleeding of a sufficient volume to require immediate intervention to prevent further blood loss), chronic (symptoms present for the majority of the preceding 6 months), or intermenstrual (bleeding between cyclically regular onset of menses).[1]

AUB affects up to 30% of women of reproductive age.[2]

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. Further investigations may include blood tests and ultrasound. The recommendations provided in this topic apply to adult women only.

See also Abnormal uterine bleeding .

Library

Solitary intramural fibroid as shown by transvaginal pelvic ultrasound (TVUS) demonstrating posterior intramural mass lying between a normal-appearing trilaminar endometrial stripe and posterior uterine serosa
Transvaginal pelvic ultrasound (TVUS) shows a midline posterior fundal fibroid greatly distorting the endometrial cavity
Sonohysterography shows several small intracavitary masses suspicious for polyps
Sonohysterography demonstrates a posterior submucous uterine fibroid deforming the posterior endometrial cavity

Citations

Key Articles

Munro MG, Critchley HOD, Fraser IS, et al. The two FIGO systems for normal and abnormal uterine bleeding symptoms and classification of causes of abnormal uterine bleeding in the reproductive years: 2018 revisions. Int J Gynaecol Obstet. 2018 Dec;143(3):393-408.[Abstract][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].[Abstract][Full Text]
American College of Obstetricians and Gynecologists. Practice bulletin no. 128: diagnosis of abnormal uterine bleeding in reproductive-aged women. Jul 2012 [internet publication].
National Institute for Health and Care Excellence. Heavy menstrual bleeding: assessment and management. Jul 2026 [internet publication].[Full Text]
American College of Radiology. ACR appropriateness criteria abnormal uterine bleeding. 2020 [internet publication].[Full Text]

Referenced Articles

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