Uterine Bleeding

What is Uterine Bleeding?

Abnormal uterine bleeding (AUB) is a broad term that describes irregularities in the menstrual cycle involving frequency, regularity, duration, and volume of flow outside of pregnancy. It is experienced usually at menarche and perimenopause.

The phenomena can be divided into acute and chronic. Acute AUB usually occurs on its own or superimposed on chronic AUB which is irregularity in menstrual bleeding for more than six months.

The prevalence of abnormal uterine bleeding among reproductive-aged women internationally is estimated to be between 3% to 30%. The exact prevalence is a little difficult to determine because most of the women do not seek treatment for the symptoms.

Aetiology

PALM-COEIN is a useful acronym provided by the International Federation of Obstetrics and Gynaecology (FIGO) to classify the underlying aetiologies of abnormal uterine bleeding. Whereas PALM defines all the structural abnormalities, COEI defines the non-structural oneעs.

• P: Polyp
• A: Adenomyosis
• L: Leiomyoma
• M: Malignancy and hyperplasia
• C: Coagulopathy
• O: Ovulatory dysfunction
• E: Endometrial disorders
• I: Iatrogenic
• N: Not otherwise classified

Conditions included in ףnot otherwise classifiedפ are pelvic inflammatory disease, chronic liver disease and cervicitis.

History and physical examination

The physician must take into account the history of the patient with respect to the menstrual period in terms of frequency, regularity, duration and the volume of flow. Sexual and reproductive history must also be taken into account. Other associated/ systemic symptoms are weight loss, pain, discharge, bowel/bladder symptoms etc are also considered.

Physical examination includes vital signs, signs of endocrine disorders, signs of coagulopathies and abdominal examination to rule out any pelvic or abdominal masses. Speculum and bimanual pelvic examination is needed as and when required.

Diagnosis

Investigational procedures include urine pregnancy test, complete blood count, ferritin, coagulation profile, thyroid function tests, prolactin. Imaging techniques like Transvaginal ultrasound, MRI, Hysteroscopy and Sonohysterography are recommended. Endometrial biopsy must be done in women who are at a high risk for hyperplasia or malignancy.

General management

Individualised treatment must be given depending on the underlying cause of abnormal uterine bleeding.

Warning: Above information provided is an overview of the disease, we strongly recommend a doctor's consultation to prevent further advancement of disease and/or development of complications.

Disclaimer: The information provided herein on request, is not to be taken as a replacement for medical advice or diagnosis or treatment of any medical condition. DO NOT SELF MEDICATE. PLEASE CONSULT YOUR PHYSICIAN FOR PROPER DIAGNOSIS AND PRESCRIPTION.