Podcast
Questions and Answers
What characterizes abnormal uterine bleeding (AUB)?
What characterizes abnormal uterine bleeding (AUB)?
Which condition qualifies as heavy menstrual bleeding (menorrhagia)?
Which condition qualifies as heavy menstrual bleeding (menorrhagia)?
What is the main difference between acute AUB and chronic AUB?
What is the main difference between acute AUB and chronic AUB?
Which term best describes the absence of menstrual cycles for more than 90 days?
Which term best describes the absence of menstrual cycles for more than 90 days?
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Which of the following is a structural cause of abnormal uterine bleeding according to the PALM-COEIN classification?
Which of the following is a structural cause of abnormal uterine bleeding according to the PALM-COEIN classification?
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What is a commonly assessed method to estimate blood loss in cases of AUB?
What is a commonly assessed method to estimate blood loss in cases of AUB?
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Which age group is most likely to experience AUB due to precocious puberty?
Which age group is most likely to experience AUB due to precocious puberty?
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What characterizes dysfunctional uterine bleeding (DUB)?
What characterizes dysfunctional uterine bleeding (DUB)?
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What is the primary purpose of endometrial ablation?
What is the primary purpose of endometrial ablation?
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In a 14-year-old girl with heavy menstrual bleeding, which condition is most likely indicated if she has no history of serious illness and a negative pregnancy test?
In a 14-year-old girl with heavy menstrual bleeding, which condition is most likely indicated if she has no history of serious illness and a negative pregnancy test?
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What is a key indication for a hysterectomy in a patient with abnormal uterine bleeding?
What is a key indication for a hysterectomy in a patient with abnormal uterine bleeding?
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For a 14-year-old girl experiencing heavy vaginal bleeding with clots, what is the most appropriate next step in management?
For a 14-year-old girl experiencing heavy vaginal bleeding with clots, what is the most appropriate next step in management?
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What is a common cause of abnormal uterine bleeding (AUB) in adolescents?
What is a common cause of abnormal uterine bleeding (AUB) in adolescents?
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In cases of heavy menstrual bleeding not related to inherited bleeding disorders, what condition should be considered?
In cases of heavy menstrual bleeding not related to inherited bleeding disorders, what condition should be considered?
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What is the role of uterine artery embolization in managing heavy menstrual bleeding?
What is the role of uterine artery embolization in managing heavy menstrual bleeding?
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What condition is least likely to be a cause of heavy menstrual bleeding in a 14-year-old?
What condition is least likely to be a cause of heavy menstrual bleeding in a 14-year-old?
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Which of the following is NOT a common cause of abnormal uterine bleeding (AUB)?
Which of the following is NOT a common cause of abnormal uterine bleeding (AUB)?
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What is the main diagnostic goal when assessing for abnormal uterine bleeding?
What is the main diagnostic goal when assessing for abnormal uterine bleeding?
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Which condition is associated with hereditary coagulopathy that can cause AUB?
Which condition is associated with hereditary coagulopathy that can cause AUB?
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Which laboratory test is essential for excluding pregnancy in patients with abnormal uterine bleeding?
Which laboratory test is essential for excluding pregnancy in patients with abnormal uterine bleeding?
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Among the following, which factor is NOT a structural cause of abnormal uterine bleeding?
Among the following, which factor is NOT a structural cause of abnormal uterine bleeding?
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What is typically the first step in the work-up of a patient presenting with AUB?
What is typically the first step in the work-up of a patient presenting with AUB?
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Which imaging technique is considered the primary diagnostic modality for identifying structural lesions in AUB cases?
Which imaging technique is considered the primary diagnostic modality for identifying structural lesions in AUB cases?
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In the investigation of abnormal uterine bleeding, which test is performed to screen for cervical infections?
In the investigation of abnormal uterine bleeding, which test is performed to screen for cervical infections?
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What is a primary indication for endometrial sampling in women younger than 45?
What is a primary indication for endometrial sampling in women younger than 45?
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Which procedure is most appropriate for diagnosing intracavitary lesions?
Which procedure is most appropriate for diagnosing intracavitary lesions?
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Which treatment is specifically indicated for hemodynamically stable patients experiencing acute AUB?
Which treatment is specifically indicated for hemodynamically stable patients experiencing acute AUB?
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What is the first-line treatment for chronic AUB aimed at significantly reducing blood loss?
What is the first-line treatment for chronic AUB aimed at significantly reducing blood loss?
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Which of the following should not be performed in cases of advanced uterine or cervical cancer?
Which of the following should not be performed in cases of advanced uterine or cervical cancer?
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What is the role of NSAIDs in managing chronic AUB?
What is the role of NSAIDs in managing chronic AUB?
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Which of the following is not a benefit of using hormonal treatment for chronic AUB?
Which of the following is not a benefit of using hormonal treatment for chronic AUB?
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In managing acute hemorrhage in unstable patients, what is the initial intravenous fluid typically administered?
In managing acute hemorrhage in unstable patients, what is the initial intravenous fluid typically administered?
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Study Notes
Introduction to Abnormal Uterine Bleeding (AUB)
- AUB is defined as abnormal variations in the menstrual cycle.
- Usual cycle length is 28 days.
- Usual bleeding duration is 5 days.
- Usual blood loss is 80ml maximum, 5ml minimum.
- Menstrual flow usually occurs regularly (7-9 days).
- AUB prevalence is 10-30% in the US.
AUB Terminologies
- Heavy Menstrual Bleeding (Menorrhagia): Excessive menstrual flow (>80ml per cycle).
- Prolonged Bleeding: Lasting longer than 8 days.
- Hypomenorrhea: Bleeding amount less than 5ml.
- Oligomenorrhea: Irregular periods with a cycle longer than 38 days.
- Polymenorrhoea: Irregular periods with a cycle shorter than 24 days.
- Amenorrhea: Absence of menstrual cycle for >90 days (regular cycle) or >6 months (irregular cycle).
- Dysfunctional Uterine Bleeding (DUB): AUB without identifiable underlying pathology.
- Postmenopausal Bleeding: Bleeding after menopause.
- Intermenstrual Bleeding (Metrorrhagia): Bleeding between periods.
Types of AUB
- Acute AUB: Sufficiently heavy bleeding requiring immediate intervention to prevent ongoing blood loss.
- Chronic AUB: Abnormal bleeding present for the past 6 months.
Blood Loss Estimation
- Method 1: Hemoglobin/Hematocrit level.
- Method 2: Number of pads/tampons per day.
- Method 3: Pictorial blood assessment chart (scoring system for pads/tampons and clots).
- A score greater than 100 correlates to >80ml blood loss, considered heavy.
Causes of AUB by Age Group
- Childhood: Abnormal bleeding, precocious puberty.
- Adolescence: Ovulation immaturity (HPO axis), coagulation defects.
- After Adolescence: Pregnancy complications, sexually transmitted diseases (STDs).
- Perimenopause: HPO axis dysfunction, endometrial hyperplasia.
- Post Menopause: Endometrial hyperplasia, malignancies, atrophy.
PALM-COEIN Classification
-
Structural (PALM):
- P: Polyp; endometrial or cervical.
- A: Adenomyosis.
- L: Leiomyoma.
- M: Malignancy (endometrial or cervical), endometrial hyperplasia.
-
Non-structural (COEIN):
- C: Coagulation disorders (e.g., von Willebrand Disease).
- O: Ovulatory dysfunction.
- E: Endometrial dysfunction, endometritis.
- I: Iatrogenic (e.g., contraceptives, anticoagulants).
- N: Non-classified (e.g., infection, AV malformation, isthmocele).
Pregnancy Complications as Causes of AUB
- Miscarriage.
- Ectopic pregnancy.
- Gestational trophoblastic diseases.
- Endometritis & cervicitis.
Non-structural causes
- Coagulopathy: Hereditary disorders (von Willebrand disease) and liver failure.
- Ovulatory Disorders: - Obesity. - Hypothyroidism. - Polycystic ovary syndrome (PCOS), congenital adrenal hyperplasia (CAH), Cushing syndrome. - Hyperprolactinemia. - HPO axis immaturity or dysfunction
Diagnostic Goals
- Rule out pregnancy.
- Rule out cancer.
- Determine underlying cause.
Work-up of the Patient
- History: Menstrual history (menarche, amount, last menstrual period [LMP]), dysmenorrhea, contraceptive history, medications, family history of bleeding disorders, AUB or malignancies.
- Examination: General (pallor, BMI, vital signs), signs of liver failure, abdominal exam (masses), gynecological exam (uterine enlargement, adnexal masses, polyps).
-
Investigations:
- Blood tests: B-HCG (pregnancy), CBC (anemia, platelets, infection), endocrine tests (thyroid, prolactin, FSH, estrogen, androgen), coagulation tests (PT, PTT).
- Cervical tests: Screening for infections (gonorrhea, chlamydia).
- Cytology (Pap smear): For cervical cancer suspicion.
- Imaging: Transvaginal ultrasound (primary modality for structural lesions), saline infusion sonography (for endometrial cavity lesions), endometrial sampling.
- Hysteroscopy
Management of Acute Hemorrhage
- Hemodynamically unstable patients: Fluid resuscitation (normal saline, lactated Ringer), blood transfusion (PRBCs, platelets, plasma).
- Hemodynamically stable patients: Medical treatment, D&C (dilatation and curettage).
Medical Treatment for Acute AUB
- Conjugated equine estrogen IV.
- Combined oral contraceptives (COC).
- High-dose medroxy progesterone acetate or norethisterone.
- Tranexamic acid.
Management of Chronic AUB
- Non-hormonal: NSAIDs (e.g., mefenamic acid), tranexamic acid.
- Hormonal: Levonorgestrel IUS, COC, DMPA, GnRH agonist, androgens.
Uterine Procedures
- Endometrial ablation: For patients who do not want to preserve fertility.
- Uterine artery embolization (UAE): For heavy bleeding from fibroids or AV malformations.
- Hysterectomy: Definitive treatment if other methods fail and fertility is not desired.
Case Scenarios
- Case 1: 14-year-old girl with irregular, heavy menses. Most likely cause is immaturity of the HPO axis.
- Case 2: 14-year-old girl with heavy, prolonged bleeding. Most likely next step in management is to administer tranexamic acid.
Summary
- AUB has structural and non-structural causes.
- Age group influences causes.
- Management depends on hemodynamic status, desire for fertility, and underlying cause.
References
- William's Gynecology 4th Edition Textbook.
- Amboss Website.
- Lecturio platform.
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Description
This quiz covers the essential concepts and terminologies related to Abnormal Uterine Bleeding (AUB). Explore definitions, prevalence, and types of abnormal bleeding patterns to enhance your understanding of menstrual health. Test your knowledge on conditions such as menorrhagia, oligomenorrhea, and more.
