Abnormal Uterine Bleeding: Etiology and Management

Study Notes

AUB is a common health concern in women, characterized by excessive or prolonged bleeding.
Mean amount of menstrual blood loss in one cycle is approximately 35 mL, but may be as much as 60 mL.
Heavy menstrual bleeding occurs in 9% to 14% of healthy women.

Measurement of hemoglobin, serum iron, serum ferritin, beta human chorionic gonadotropin, thyroid-stimulating hormone, and prolactin levels.
Endometrial biopsy and hysteroscopy.
Sonohysterography and hysterosalpingography.
Magnetic Resonance Imaging (MRI) may be helpful in diagnosing adenomyosis or surgical planning for leiomyoma.

Localized overgrowths of endometrial tissue, containing glands, stroma, and blood vessels, covered with epithelium.
Most commonly found in reproductive-age women.
Estrogen stimulation plays a key role in their development.

Defined by the presence of endometrial glands and stroma in the uterine myometrium.
Can occur as focal (adenomyoma) or diffuse.
Peak incidence in the fifth decade of life.
Multiparity is considered the most significant risk factor.

Benign tumors of the uterine myometrium.
Can cause abnormal bleeding due to size, location, and number.
Subclassification of leiomyomas:
- Type 0: Intracavitary fibroids.
- Type 1: Submucosal fibroids, more than 50% intracavitary.
- Type 2: Submucosal fibroids, less than 50% intracavitary.

Systemic diseases, particularly disorders of blood coagulation, may initially present as AUB.
Von Willebrand disease and prothrombin deficiency are examples.
Routine screening for coagulation defects is mainly indicated for adolescents with prolonged heavy menses.

High doses of oral or intravenous estrogen usually stop acute bleeding episodes.
Tranexamic acid (TXA) stops bleeding in most cases.
Alternative regimen is high-dose oral progestogen for a week, with tapering of the dosage thereafter.
Oral contraceptives, nonsteroidal anti-inflammatory drugs, TXA, or a prolonged course of progestogens, or levonorgestrel released locally from an intrauterine system (LNG-IUS) may be used.### Abnormal Uterine Bleeding (AUB)
AUB can be caused by various factors, including hormonal imbalances, coagulopathies, and anatomical abnormalities.

Leiomyomas can be classified using the PALM-COEIN system
A subscript 0 indicates the absence of leiomyomas, while a number 1 indicates their presence
The letters SM can be inserted to indicate a fibroid's location as submucosal

Hemophilias A and B are X-linked recessive deficiencies of factor VIII and factor IX, respectively
Women who are carriers for these disorders can have reduced levels of factors VIII and IX, leading to mild hemophilia
Rare inherited coagulopathies of other clotting factors (V, VII, X, XI, XIII) can also cause menorrhagia
Disorders that produce platelet deficiency, such as leukemia, severe sepsis, idiopathic thrombocytopenic purpura, and hypersplenism, can cause excessive bleeding
Chronic anticoagulation as a result of medications like heparin, low-molecular-weight heparin, direct thrombin inhibitors, and direct factor Xa inhibitors can also lead to bleeding

Malignancies associated with the female reproductive tract include vulvar, vaginal, cervical, endometrial, uterine, and adnexal (ovarian or fallopian tube) cancers