Abnormal Uterine Bleeding

Description

Introduction overview of Abnormal Uterine Bleeding (AUB), beginning with the pathophysiology of normal menstruation (progesterone withdrawal, prostaglandins, fibrinolysis, platelet plug formation) and defining normal cycles based on FIGO parameters—regularity, frequency (24–38 days), duration (≤8 days), and volume (≤80 mL). Structural Causes covers the structural causes of AUB (PALM – Polyp, Adenomyosis, Leiomyoma, Malignancy/Hyperplasia) with emphasis on clinical presentation, risk factors, imaging findings, and exam-oriented diagnostic approach. It highlights key clues such as intermenstrual bleeding in polyps, heavy bleeding with dysmenorrhea in adenomyosis, pressure symptoms with fibroids, and the stepwise progression from unopposed estrogen → hyperplasia → endometrial cancer. It also include TVS as first-line imaging, hysteroscopy as gold standard for intrauterine lesions, endometrial biopsy for suspected malignancy, and punch biopsy (not Pap smear) for visible cervical growth. Non – Structural Causes explains of non-structural causes of AUB (COEIN)—especially AUB-C (coagulopathy, including von Willebrand disease), AUB-O (anovulatory bleeding), AUB-E (endometrial dysfunction), AUB-I (iatrogenic causes), and AUB-N (AV malformations)—with clear pathophysiological mechanisms. It emphasizes screening red flags, essential investigations (CBC, PT, aPTT, vWF assays), differentiation of ovulatory vs anovulatory bleeding patterns, prostaglandin imbalance, drug-induced bleeding, and AVM diagnosis with Doppler. Evaluation of AUB emphasizing mandatory exclusion of pregnancy, age-based etiological clues, detailed menstrual history, focused examination, and targeted investigations including CBC, TSH, prolactin, coagulation profile, and TVS as first-line imaging. It also highlights indications for endometrial biopsy (≥45 years or <45 years with risk factors for unopposed estrogen), the role of saline infusion sonography and hysteroscopy for focal lesions. Management of AUB & Specific Management covers overview of medical and surgical management of Abnormal Uterine Bleeding (AUB), detailing non-hormonal (NSAIDs, tranexamic acid), hormonal (OCPs, progesterones, LNG-IUS), and other agents (GnRH analogs, danazol, SERMs), along with acute heavy bleeding protocols and anemia correction. Also covers indication-based surgical options including D&C, endometrial ablation, uterine artery embolization, and hysterectomy, with cause-specific management under PALM–COEIN—highlighting key contraindications, fertility considerations. Rapid Revision defining normal menstruation using FIGO parameters (regularity, frequency 24–38 days, duration ≤8 days, volume ≤80 mL) and outlining a stepwise evaluation approach—pregnancy exclusion, targeted labs, TVS, and indications for endometrial biopsy. Provides an exam-focused management algorithm covering acute bleeding control, chronic AUB treatment (OCPs, progesterones, LNG-IUS as first line).