Abnormal Uterine Bleeding (AUB)

 

Abnormal Uterine Bleeding (AUB)

Disorders of menstrual bleeding, now termed AUB.  Abnormal uterine bleeding (AUB) is bleeding from the uterus that is longer than usual or that occurs at an irregular time. Bleeding may be heavier or lighter than usual and occur often or randomly. AUB can occur: As spotting or bleeding between your periods. Although rarely life threatening, menstrual disorders can cause major social, psychological and occupational upset.

Types of abnormal bleeding:

There are several types of abnormal bleeding and their terminology should be known;

1.     Heavy menstrual bleeding (HMB)  

2.     Intermenstrual bleeding (IMB)

3.     Postcoital bleeding (PCB)

4.     Postmenopausal bleeding (PMB)

Causes of abnormal uterine bleeding

The most common causes of such bleeding are uterine fibroids, uterine adenomyosis, or endometrial polyps. Fibroids are benign masses in the muscle layer of the uterus (myometrium), while adenomyosis is a condition in which the lining of the uterus (endometrium) grows into the myometrium.

Signs and symptoms of abnormal uterine bleeding

1.     Heavy menstrual bleeding (formerly called menorrhagia).

2.     Bleeding at unusual times (between periods, after intercourse).

3.     Unusually long periods (seven days or longer).

4.     Inconsistent menstrual cycles.

Investigation of abnormal uterine bleeding

1.     Initial investigations for each include;

2.     Speculum examination of the cervix, with swabs for microbiology

3.     Cervical smear if indicated

4.     Transvaginal ultrasound scan (TVUSS)

5.     Endometrial biopsy (EB) as necessary.

6.     Further to this, outpatient

·        hysteroscopy

·        biopsy

 Treatment of abnormal uterine bleeding

Dysfunctional uterine bleeding can be treated;

·        Medically

·        Surgically

 Medical treatment:

It consists of anti-fibrinolytic tranexamic acid, non-steroidal anti-inflammatory drugs, the combined contraception pill, progestogen, danazol, or analogues of gonadotrophin releasing hormone.

Surgical treatment:

It include dilation and curettage (D&C), endometrial ablation, uterine artery embolization, and hysterectomy. The choice of surgical modality (eg, D&C versus hysterectomy) is based on the aforementioned factors plus the patient's desire for future fertility.

 

Terminologies for common types of AUB

• HMB:

Excessive menstrual blood loss (this chapter).

• IMB:

 Bleeding between periods, often seen with endometrial and cervical polyps .

• PCB:

Bleeding after sex. Often associated with cervical abnormalities.

• PMB:

 Bleeding more than 1 year after cessation of periods. Exclude endometrial pathology or vaginal atrophy.

• BEO:

‘Bleeding of endometrial origin’, a diagnosis of exclusion, has replaced the term ‘dysfunctional uterine bleeding’ (DUB).