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●Frequency – 24 to 38 days
●Regularity – Variation ≤7 to 9 days
●Duration – ≤8 days
●Volume –a volume that does not interfere with a woman's
physical, social, emotional, and/or material quality of life.
Research definition is ≤80 mL vaginal "blood" loss per cycle
• Abnormal uterine bleeding , describes any symptomatic
variation from normal menstruation and covers the full
range of symptoms of abnormal bleeding.
• Acute AUB :
An episode of uterine bleeding that is of sufficient quantity
to require immediate intervention to prevent further blood
loss.
• Chronic AUB:
Bleeding from the uterine body (or corpus), that is abnormal
in frequency, regularity, duration, and/or volume, and has
been present for at least the majority of the past six months
●If periods start more often than every 24 days, the patient
is categorized as having frequent uterine bleeding.
●If they start less often than every 38 days, the category is
infrequent. the term oligomenorrhea is replaced by the
term infrequent uterine bleeding
Diagnosis:
• Ultrasound
• Saline infusion sonogram hysteroscopy ( the gold standard)
Adenomyosis (AUB-A)
The spectrum of findings in u/s includes:
What is her normal menstrual cycle like? Are there symptoms of ovulation? IS BLEEDING
ANOVULATORY OR OVULATORY? Contraceptive method?
What is the nature of the abnormal bleeding (frequency, duration, volume, relationship to
activities such as coitus)? Are there any associated symptoms, pain ?
Has there been a change in weight, possibly associated with an eating disorder, excessive
exercise, illness, or stress? fever, and/or vaginal discharge ? Changes in bladder or bowel
function ?
Is there a personal or family history of a bleeding disorder? Gyneacological cancer?
Hx of surgery C.S?
Heavy menstrual bleeding
a) Endometrial polyps
b) contraceptive method
c) Endometrial hyperplasia or carcinoma
d) Endometritis or PID
e) conditions of the cervix
LABORATORY EVALUATION
• Pregnancy test
• Complete blood count
Additional tests depend upon information obtained on history and
physical examination:
• Endocrine tests
i. -Thyroid function tests
ii. -Prolactin level
iii. -Androgen levels
iv. -Follicle-stimulating hormone or luteinizing hormone
v. -Estrogen levels
• Coagulation tests
• Cervical cancer screening
• Tests for cervicitis
Indications for endometrial sampling in women of reproductive-
age with AUB vary by age group :
• Age 45 years to menopause:
- Any AUB, including intermenstrual bleeding.
- Bleeding that is frequent (interval between the
Onset of bleeding episodes is <21 days)
- Heavy
- Prolonged (>5 days)
• Younger than 45 years:
- If AUB is persistent
- occurs in the setting of a history of unopposed
estrogen exposure (obesity, chronic anovulation)
- failed medical management of the bleeding
- women at high risk of endometrial cancer
a) Office endometrial biopsy
b) D&C
c) Hysteroscopic guide D & C
• Pelvic ultrasound is the first-line imaging study in women
with AUB.