Dysfunctional uterine bleeding dub is often caused by a hormonal imbalance. Ovulatory bleeding occurs at regular menstrual intervals and is typically associated with premenstrual symptoms and painful periods. Abnormal uterine bleeding aub may be acute or chronic and is defined as bleeding from the uterine corpus that is abnormal in regularity, volume, frequency, or duration and occurs in the absence of pregnancy 1 2. Interventions included the levonorgestrel intrauterine. Consider alternate contraceptive method according to patient wishes. Imaging tests such as pelvic ultrasound, transvaginal ultrasound, ultrasound of the uterus, pelvic. Mar 02, 2020 menstruation, or period, is a womans monthly bleeding.
Dysfunctional uterine bleeding is the diagnosis in 4060% of women with excessive menstrual bleeding which is defined as greater than 80 ml blood loss normal menstrual loss heavy menstrual bleeding may affect a womans health both medically and socially, causing problems such as iron deficiency anaemia and social phobia respectively. Clinical practice clinical update dysfunctional uterine. The reasons for the wide spectrum of estimatesare unclear but vary with age, being higher in adolescents and in the fifthdecade of life, and varying somewhat with country of. Dysfunctional uterine bleeding and uterine fibroids. Some of the more common structural causes of abnormal uterine bleeding include benign noncancerous lesions of the uterus such as polyps, fibroids myomas.
Aub may be accompanied by pain and discomfort, cause significant social embarrassment, and have a substantial effect on healthrelated quality of life. Abnormal uterine bleeding symptoms, diagnosis and treatment. Blood samples were collected on the next day or on the same day if patients were fasting. Abnormal uterine bleeding aub is a condition that affects approximately 30% of women during their reproductive years. Evaluation and management of abnormal uterine bleeding. Heavy menstrual bleeding is the commonest cause of irondeficiency anaemia in the western world. Abnormal uterine bleeding in the adolescent patient. We focused on interventions that are suitable for use in primary care practice including medical, behavioral, and complementary and alternative medicine approaches.
The opening of the uterus at the top of the vagina. Develop a treatment plan to include nonsurgical and surgical options. Menstrual flow outside of normal volume, duration, regularity, or frequency is considered abnormal uterine bleeding aub. Aub frequently coexists with fibroids, but the relationship between the two remains incompletely understood and in many women the identification of fibroids may be incidental to a menstrual bleeding complaint. Abnormal bleeding caused by hormone imbalance is more common in teenagers or in women who are approaching menopause. Abnormal uterine bleeding aub evaluation diagnosis of abnormal uterine bleeding in reproductiveaged women. The worldwide impact of abnormal uterine bleeding aub in the reproductiveyears is substantial,with a prevalenceof approximately 3%30% among reproductiveaged women. Single measurement of serum prolactin was done in the. This chapter examines the modes of presentation and the causes of such symptoms, which range from physiological variations to more sinister underlying pathology. Apr 02, 2017 abnormal uterine bleeding can also occur when a woman doesnt ovulate. Abnormal uterine bleeding related to ovulatory dysfunction i. The most common cause of dub is deficient or excessive production of estrogen andor progesterone. Many, however, are unaware of common causes of abnormal bleeding and available treatment options. A the bleeding may be abnormal because of how heavy it is or when it happens, such as.
It reflects an interruption in the normal cyclic pattern of ovulatory hormonal stimulation to the endometrial lining. Abnormal uterine bleeding aub is any variance of the normal menstrual cycle, which is defined on the basis of four parameters frequency, regularity, duration, and volume. The prevalence of symptomatic or clinically relevant cesarean scar defects csds ranges from 19. Figo classification system palmcoein for causes of abnormal. Abnormal uterine bleeding may be caused by a variety of factors. Abnormal uterine bleeding aub is a common and debilitating condition with high direct and indirect costs.
When uterine cancer is found early, treatment is most effective. Abnormal uterine bleeding is a common problem encountered in general practice. In women of childbearing age, a methodical history, physical examination, and laboratory evaluation may enable. Abnormal uterine bleeding is a common presenting symptom in the family practice setting. Dysfunctional uterine bleeding dub is a common disorder of excessive uterine bleeding affecting premenopausal women that is not due to pregnancy or any recognisable uterine or systemic diseases. Abnormal uterine bleeding is a broad term that indicates a change in frequency of menses, duration of flow or amount of blood loss. The evaluation and management of any abnormal uterine bleeding is a complex process involving many decisions being made concurrently. Aub frequently coexists with fibroids, but the relationship between the two remains incompletely understood and in many women the identification of fibroids may be incidental to a menstrual bleeding. What factors are considered when deciding on a type of treatment. Abnormal uterine bleeding dysfunctional uterine bleeding ncbi. Abnormal uterine bleeding aub may be acute or chronic and is defined as bleeding from the uterine corpus that is abnormal in regularity, volume, frequency. Abnormal uterine bleeding aub is defined as changes in frequency of menses, duration of flow or amount of blood loss. Abnormal uterine bleeding geneva foundation for medical. Diagnosis of abnormal uterine bleeding in reproductiveaged.
This has been highlighted in the rcog guidelines with an exception of. The underlying pathophysiology is believed to be due to ovarian hormonal dysfunction. Management of women with bleeding irregulatories while sing contraception, u. Abnormal uterine bleeding aub is now classified and categorized according to interna tional federation of gynecology and obstetrics guidelines. A common and often debilitating condition, affecting women of reproductive age. Selected practice recommendations for contraceptive use, 20, national center for chronic disease prevention and health promotion, division of reproductive health, centers for disease control and. Dysfunctional uterine bleeding dub is a diagnosis of exclusion when there is no pelvic pathology or underlying medical cause. At what ages is abnormal uterine bleeding more common. Keeping current with causes of and treatments for abnormal uterine bleeding aub is important. One third of outpatient visits to the gynecologist are for aub, and it accounts for more than 70% of all gynecologic consults in the perimenopausal and postmenopausal years 1. Abnormal uterine bleeding murtaghs general practice, 7e. Abnormal uterine bleeding aub is an atypical loss of blood from the uterine cavity that occurs outside of the menstrual c ycle. In the treatment of women with abnormal uterine bleeding, once a thorough history, physical examination, and indicated imaging studies are performed and all significant structural causes are excluded, medical management is the firstline approach.
This revision is part of the series, guidelines and recommendations. This will depend on the cause of the abnormal uterine bleeding if a chronic illness or a blood disorder is at the root of your symptoms, treating that can help. The medical management of abnormal uterine bleeding in. Abnormal uterine bleeding is a broad term that indicates a change in frequency of menses, duration of flow or. A pregnancy that implants outside of the uterus, usually in the fallopian tube. Define the pathophysiology of abnormal uterine bleeding. Abnormal uterine bleeding and uterine fibroids commercial.
It may impact physical, emotional sexual and professional aspects of the lives of women, impairing their quality of life. Pdf abnormal uterine bleeding aub is a common and debilitating condition with high direct and indirect costs. Figo classification system palmcoein for causes of. It is a diagnosis of exclusion made after structural causes of bleeding and chronic medical diseases have been ruled out. Dub is typically characterized by heavy prolonged flow with or without breakthrough bleeding. Aub refers to bleeding that is excessive or occurs outside of normal cyclic menstruation. Clinical diagnosis of abnormal uterine bleeding was established based on the history provided by the patients. Abnormal uterine bleeding american family physician. Abnormal uterine bleeding occurs when either the frequency or quantity of uterine bleeding differs from that mentioned above or the woman has spotting or bleeding between her menstrual periods. Abnormal uterine bleeding between menarche and menopause figure 2. Application with clinical presentations through diagnostic workup and treatment strategies. Cer 96 primary care management of abnormal uterine. This includes procedures that use a resectoscope to surgically remove, electrically desiccate or vaporize the endometrium, as well as laser destruction of the. Further evaluation of abnormal uterine bleeding depends on the patients age and the presence of risk factors for endometrial cancer, which include anovulatory cycles, obesity, nulliparity, age greater than 35 years, and tamoxifen therapy.
Abnormal uterine bleeding aub is a broad term that describes irregularities in the menstrual cycle involving frequency, regularity, duration. Because of this complexity, concise guidelines have been difficult to develop. It is responsible for about half of the women with abnormal uterine bleeding in reproductive age ewenstein, 1996. Bleeding from the uterus that differs in frequency, regularity, duration, or amount from normal uterine bleeding in the absence of pregnancy. Chronic abnormal uterine bleeding aub, a term that refers to menstrual bleeding of abnormal quantity, duration, or schedule, is a common gynecologic problem, occurring in approximately 10 to 35 percent of women. Abnormal uterine bleeding might be classified as premenopausal, perimenopausal, or postmenopausal. Other causes of abnormal bleeding must also be ruled out, including. Evaluation and management of abnormal uterine bleeding in.
A classification of abnormal uterine bleeding is presented in table 102. Treatment options for dysfunctional uterine bleeding. Primary care management of abnormal uterine bleeding. The two figo systems for normal and abnormal uterine bleeding. Abnormal uterine bleeding and uterine fibroids page 2 of 19 unitedhealthcare commercial medical policy effective 04012020 proprietary information of unitedhealthcare. Abnormal uterine bleeding is a common problem, and its management can be complex. Guidelines for the management of abnormal uterine bleeding. Postmenopausal women with abnormal uterine bleeding should be.
In cases of acute and severe bleeding, women may need urgent treatment with. Cer 96 primary care management of abnormal uterine bleeding. Mri, hysteroscopy or endometrial biopsy also may be used to. Acog releases guidelines on management of abnormal uterine. Currently, there are no guidelines for comprehensive evaluation and management of dub, and most existing guidelines focus on narrow and specific etiology and age groups.
Uterine causes can include leiomyomas, infection, polyps, endometrial hyperplasia, endometrial intraepithelial neoplasia, carcinoma, or the presence of a foreign body. Dysfunctional uterine bleeding dub, the most common cause of abnormal uterine bleeding, occurs most often in women 45 50% of cases and in adolescents 20% of cases. American college of obstetricians and gynecologists. Management of acute abnormal uterine bleeding in nonpregnant. Dysfunctional uterine bleeding describes the sp ectrum of abnormal bleeding patterns in the abscence of a medical illness or pelvic pathology. The recommendations in this guideline represent the view of nice, arrived at after careful. Continued abnormal bleeding after 6 months bothersome irregular bleeding amenorrhea or scant infrequent bleeding counsel patient that this is expected pattern. Abnormal uterine bleeding is an extremely common indication for referral to a gynaecologist.
Abnormal uterine bleeding is one of the most common reasons for women to seek for care. Discuss the palmcoein classification system for diagnostic workup. Abnormal uterine bleeding is a frequent condition in gynecology. Abnormal uterine bleeding aub in nonpregnant reproductiveage women is a common gynecologic symptom. Cervical cancer, infection, trauma, or polyps can cause abnormal vaginal bleeding. Aub can have a major impact on womens lives in terms of health care expenses, productivity, and quality of life. Gynecology the two figo systems for normal and abnormal. What medications are used to help control abnormal uterine bleeding. Abnormal uterine bleeding previously, dysfunctional uterine bleeding dub is irregular uterine bleeding that happens in the absence of recognizable pelvic pathology, basic medical disease, or pregnancy. Laboratory workup of adolescents with abnormal uterine bleeding should include a. Abnormal uterine bleeding is a common reason for women to visit their primary care clinician, accounting for about 20% of gynecologic primary care visits. The investigation and management of abnormal uterine bleeding. It could be bleeding that is between periods, is very heavy, or lasts much longer than usual. Nov 26, 2017 when it comes to menstrual cycles, theres a wide range of normal.
Abnormal uterine bleeding murtaghs general practice, 6e. In premenopausal and perimenopausal women, aub can be further categorized as ovulatory and anovulatory. Abnormal uterine bleeding has been shown to adversely affect mood, energyvitality, work productivity, social interactions, family life and sexual functioning. What tests may be needed to diagnose abnormal uterine bleeding. Michael evans developed the onepager concept to provide clinicians with useful clinical information on primary care topics. Abnormal uterine bleeding aub is a common problem among women in the reproductive age. National collaborating centre for womens and childrens health, national institute of clinical excellence. Prolactin level in women with abnormal uterine bleeding. Dysfunctional uterine bleeding dub represents a particular type of abnormal uterine bleeding aub, and is defined in the usa as an excessive, prolonged and irregular bleeding of the endometrium. These are just a few of the problems that can cause abnormal uterine bleeding. The proposed mechanism of abnormal uterine bleeding is a pouch or isthmocele in the lower uterine segment that causes delayed menstrual bleeding.
Aub can have a major impact on womens lives in terms of health care. Management of abnormal uterine bleeding in reproductive period. Dysfunctional uterine bleeding is the occurrence of uterine bleeding unrelated to structural abnormalities of the uterus or the endometrial lining. Management of women with bleeding irregulatories while. Menstrual disorders and abnormal uterine bleeding aub are among the most frequent gynecologic complaints in adolescents. Abnormal uterine bleeding obstetrics and gynecology clinics. Abnormal uterine bleeding miscarriage ectopic pregnancy certain types of cancer, such as cancer of the uterus your obstetriciangynecologist obgyn or other health care professional may start by checking for problems most common in your age group. Abnormal uterine bleeding in the adolescent patient 26 the female patient vol 35 july 2010 all articles are available online at females should receive testing for sexually transmitted infections. Clinical policy effective11012011 19962012, oxford health plans, llc 3 manual endometrial ablation. Abnormal uterine bleeding with no evidence of mechanical or structural cause. Acute aub refers to an episode of heavy bleeding that, in the opinion of the clinician, is of sufficient quantity to require immediate intervention to prevent further blood loss 1. Aub leads to loss of productivity1 and may result in surgical interventions including hysterectomy2. In postmenopausal women, abnormal uterine bleeding includes vaginal bleeding six months or more after the cessation of menses, or unpredictable bleeding in. It also includes bleeding that happens before puberty or after menopause.
Abnormal uterine bleeding aub is a common and debilitating condition with high. The association of thyroid disorders with abnormal uterine. Pregnancy is the first consideration in women of childbearing age who present with abnormal uterine bleeding table 1. Health care practitioners deal with this problem frequently. Aub is described by a variety of terms and may be caused by a number of genital and nongenital tract diseases, systemic disorders, and medications. These problems can occur at any age, but the likely cause of abnormal uterine bleeding usually depends on your age. During the menstrual cycle, one of the ovaries releases a mature egg in a process called ovulation. Aub system 1 is seen in figure 1, with changes summarized in table 1. Some of them are not serious and are easy to treat. Abnormal vaginal bleeding is different from normal menstrual periods. As recently defined by the international federation of gynecology and obstetrics figoand endorsed by the american college of obstetricians and gynecologiststhe term abnormal uterine bleeding aub now describes any departure from normal menstrual bleeding. Over the history of medicine, there has been a wide range of poorly defined terminology used to describe aub symptoms and etiologies. Abnormal uterine bleeding has various definitions and.
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