08/12/2025
ABNORMAL UTERINE BLEEDING
A. DEFINITIONS
1. Clinical Medicine Definition
• Abnormal Uterine Bleeding is any deviation in a woman’s menstrual blood loss—whether in volume, frequency, regularity, or duration—that falls outside the limits of normal cyclic menstruation and cannot be explained by pregnancy.
2. Gynecology Textbook Definition
• AUB is a symptom characterized by uterine bleeding that is unpredictable in timing or excessive in amount, arising from structural or functional disturbances of the female reproductive system.
3. Pathophysiological Definition
• AUB refers to menstrual bleeding that results from alterations in the normal hormonal regulation of the menstrual cycle or from pathologies affecting the uterus, endometrium, or ovulatory mechanisms.
4. Reproductive Endocrinology Definition
• AUB is a manifestation of disrupted endocrine signaling or endometrial responsiveness, leading to bleeding that is heavier, prolonged, irregular, or occurring between normal menstrual periods.
5. Research / Scientific Definition
• Abnormal Uterine Bleeding is a clinical entity in which menstrual bleeding patterns differ from the established norms (24–38-day cycle, 4.5–8-day duration, 5–80 mL blood loss), indicating potential underlying systemic, structural, or hormonal abnormalities.
6. Public Health / Women's Health Definition
• AUB is a common women’s health concern where menstrual bleeding occurs in ways that affect physical wellbeing, emotional health, or daily functioning, often requiring medical evaluation to determine the cause.
6. World Health Organization (WHO) Definition of AUB
The WHO defines Abnormal Uterine Bleeding as:
“Any bleeding from the uterus that is abnormal in volume, regularity, frequency, or duration and occurs in the absence of pregnancy.”
B.CAUSES OF AUB
1. Pregnancy-Related Causes
Implantation bleeding
Threatened abortion
Inevitable/incomplete/complete abortion
Ectopic pregnancy
Molar pregnancy
Placenta previa
Abruptio placentae
Vasa previa
2. Hormonal Causes
Anovulation (PCOS, thyroid disorders, hyperprolactinemia, perimenopause, POI)
Luteal phase defect
Obesity (increased estrogen)
Stress, extreme weight changes
Medications (hormonal contraception, antipsychotics)
3. Trauma-Related Causes
Sexual assault / in*******se injury
Unsafe abortion
Pelvic trauma
Uterine rupture
Cervical laceration during childbirth
Iatrogenic trauma (IUD, D&C, biopsies)
4. Malignancy-Related Causes
Endometrial: hyperplasia, carcinoma
Cervical: dysplasia, cancer
Vaginal/vulvar cancer
Uterine sarcoma
C.AUB MANAGEMENT PROTOCOL
• Divided into Emergency (unstable patient) and Chronic (stable patient).
A. EMERGENCY MANAGEMENT OF AUB
1. Assess ABCs
Airway, breathing, circulation
IV access (2 large-bore lines), O₂, monitor vitals
2. Determine hemodynamic stability
• If unstable → immediate resuscitation & gynecology referral
3. Labs
CBC, RFT, LFT
β-hCG (pregnancy test mandatory)
Coagulation profile
Type & crossmatch
4. Medical Management
A. If severe bleeding but patient stable:
High-dose IV estrogen
OR high dose combined OCPs
OR High dose progestins (if estrogen is contraindicated)
Tranexamic acid (TXA)
NSAIDs (reduce prostaglandins)
B. If medical therapy fails:
Uterine tamponade (Bakri balloon, Foley)
D&C (diagnostic + therapeutic)
Uterine artery embolization
Surgical options (hysterectomy)
B. CHRONIC AUB MANAGEMENT
• (For stable patient)
Step 1: Identify the Cause
Pregnancy?
According the above classification
Labs: CBC, TSH, prolactin
Pelvic ultrasound
Endometrial biopsy if >45 years or cancer risk
Step 2: Medical Treatment
1. Hormonal
Combined oral contraceptives
Progestin pills (cyclic or continuous)
Depot medroxyprogesterone (DMPA)
LNG-IUS (Mirena) → most effective long-term management
2. Non-Hormonal
Tranexamic acid
NSAIDs
Iron supplementation for anemia
3. Treat underlying cause
PCOS → weight loss, metformin, OCP
Thyroid disease → treat thyroid disorder
Hyperprolactinemia → dopamine agonists
Fibroids → myomectomy, embolization
Polyps → removal
Malignancy → oncology referral
Contacts
Email: Nour Mahamoud [email protected]
Whatssapp: +252637423353
