Management of abnormal uterine bleeding in reproductive. Hkcog guidelines number 5 may 2001 1 hkcog guidelines guidelines on investigation of women with abnormal uterine bleeding under the age of 40 published by the hong kong college of obstetricians and gynaecologists a foundation college of hong kong academy of medicine number 5 may 2001 1 introduction abnormal uterine bleeding aub is a. Anovulatory dysfunctional uterine bleeding may therefore occur and results in irregular, prolonged, and sometimes heavy menstrual bleeding. Sep 11, 2015 in premopausal women with normal findings on physical examination, the most likely diagnosis is dysfunctional uterine bleeding dub secondary to anovulation, and the diagnostic investigation is targeted at identifying the etiology of anovulation. A new classification system has been created to provide a universally accepted system of nomenclature to describe uterine bleeding causes in reproductiveaged women. It may be caused by trauma, a foreign body such as toys, coins, or toilet tissue, irritation of the genital area due to bubble bath, soaps, lotions, or infection, or urinary tract problems. The objective of this study was to evaluate the endometrial biopsy patterns in an indigent population of women with abnormal uterine bleeding.
Acog, this article uses the term anovulatory abnormal uterine bleeding. Single measurement of serum prolactin was done in the. Once conditions of pregnancy, infection, structural abnormalities, and hormonal causes have been ruled out, firstline treatment is medical. 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.
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. Gynecology the two figo systems for normal and abnormal. Abnormal uterine bleeding in premenopausal women replaces no. The american college of obstetricians and gynecologists has issued updated guidelines for treating abnormal uterine bleeding caused by ovulatory dysfunction. Acog releases guidelines on management of abnormal. 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. Pdf on jan 1, 2012, micah j hill and others published acog practice bulletin.
Laboratory workup of adolescents with abnormal uterine bleeding should include a preg. 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. In cases of acute and severe bleeding, women may need urgent treatment with. Abnormal uterine bleeding can be caused by many different conditions. The acronym palmcoein polyp, adenomyosis, leiomyoma, malignancy and hyperplasia, coagulopathy, ovulatory. 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.
The figo systems first define the abnormal uterine bleeding, then give an. Abnormal dysfunctional uterine bleeding in pediatrics. Many, however, are unaware of common causes of abnormal bleeding and available treatment options. Chart and diagram slides for powerpoint beautifully designed chart and diagram s for powerpoint with visually stunning graphics and animation effects. Abnormal uterine bleeding aub is a broad term that describes irregularities in. Abnormal uterine bleeding aub is a common problem among women in the reproductive age.
Hkcog guidelines number 5 may 2001 hkcog guidelines number. Abnormal uterine bleeding aub is a condition that affects approximately 30% of women during their reproductive years. Dub is typically characterized by heavy prolonged flow with or without breakthrough bleeding. The term dysfunctional uterine bleeding was used when no underlying cause was present. Jul 08, 2019 aub occurs most often in the beginning and end of the reproductive years. Bleeding that occurs erratically or excessive regular menstrual bleeding is considered to be abnormal uterine bleeding. It reflects a disruption in the normal cyclic pattern of ovulatory hormonal stimulation to the endometrial lining. Postmenopausal bleeding pmb refers to any uterine bleeding in a menopausal woman other than the expected cyclic bleeding that occurs in women taking cyclic postmenopausal hormone therapy.
Abnormal uterine bleeding is further clas occurs less frequently than every 35 days. Abnormal uterine bleeding occurs in 9 to 14 percent of women between menarche and menopause, significantly impacting quality of life and imposing financial burden. Adolescents in particular may have tremendous variability in their cycles until their hormone levels balance out after several years of menstruation. As the most common cause of abnormal uterine bleeding, it affects both ends of the reproductive spectrum that is, teens and perimenopausal women. It reflects an abnormal volume of blood loss during the menstrual cycle. Aub is responsible for significant health problem and social embarrassment and. Evaluation and management of abnormal uterine bleeding in. Aub frequently coexists with fibroids, but the relationship between the two remains. Menstrual flow outside of normal volume, duration, regularity, or frequency is considered abnormal uterine bleeding.
The international federation of gynecology and obstetrics and the american congress of obstetricians and gynecologists support the use of new terminology for abnormal uterine bleeding. 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. 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 uterine bleeding aub is a common and debilitating condition with high direct and indirect costs. Heavy menstrual bleeding at menarche and in adolescence may be an important. Of these, approximately 20% are performed in women with a normal uterine size. Diagnosis of abnormal uterine bleeding in reproductive.
Abnormal uterine bleeding around the time of the menopause is common and may be a sign of premalignancy such as endometrial hyperplasia or even endometrial carcinoma. Management of abnormal uterine bleeding associated with. Anovulatory uterine bleeding abnormal uterine bleeding aub. Diagnosing the cause of abnormal uterine bleeding starts with a. 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. 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. Abnormal uterine bleeding is a common reason for women to visit their primary care clinician, accounting for about 20% of gynecologic primary care visits. Endometrial ablation refers to a number of minimally invasive surgical procedures designed to treat abnormal uterine bleeding in selected women who have no desire for future fertility. Guidelines for the management of abnormal uterine bleeding. Classification and the diagnostics of abnormal uterine.
Menstrual cycles that are longer than 38 days or shorter than 24 days irregular periods in which cycle length varies by more than 79 days. Ppt abnormal uterine bleeding powerpoint presentation. Abnormal uterine bleeding aub is defined as changes in frequency of menses, duration of flow or amount of blood loss. The abnormal uterine bleeding pamphlet presents easytoread information for patients with this condition. Bleeding in any of the following situations is considered abnormal uterine. Approach to abnormal uterine bleeding in nonpregnant reproductiveage women. Treatment options for the adolescent patient experiencing. Abnormal uterine womb bleeding is a common problem in women. Endometrial biopsy results in women with abnormal uterine. Management of abnormal uterine bleeding associated with ovulatory dysfunction. African american 4 women are more likely to have nonendometrioid, highgrade tumors known as type ii, which are associated with a more advanced stage of disease stage iii and stage iv at the time of diagnosis, compared with caucasian. Abnormal uterine bleeding can occur as either a change in your normal menstrual period or as bleeding in between your normal menses.
Evaluation and management of adolescents with abnormal. The american college of obstetrics and gynecology acog has. Heavy menstrual bleeding hmb is a common complaint among adolescent girls. All such women therefore need uterine assessment, which may include transvaginal scan combined with endometrial biopsy, hysteroscopy or a sonohysterogram. Diagnosis of abnormal uterine bleeding in reproductiveaged women. Abnormal uterine bleeding aub is the name currently used for changes in. 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. Management of abnormal uterine bleeding in reproductive period. Abnormal uterine bleeding is a very common condition among women of any age. It may impact physical, emotional sexual and professional aspects of the lives of women, impairing their quality of life. Of these cases of aub, about 90% are due to menstrual. Abnormal uterine bleeding investigations bmj best practice. Chronic heavy or prolonged uterine bleeding can result in anemia, interfere with daily activities, and raise concerns about uterine.
Evaluation of adolescent girls who present with heavy menstrual bleeding should. A wide range of treatments are used, depending on the reason for the uterine bleeding and your personal needs and conditions. Menstrual flow outside of normal volume, duration, regularity, or frequency is considered abnormal uterine bleeding aub. Abnormal uterine bleeding is a frequent condition in gynecology. To design a universally accepted system for describing bleeding problems in reproductiveaged women, a new classification system was created named for the acronym palmcoein polyp, adenomyosis, leiomyoma, malignancy and hyperpla. Its prevalence, causes and management in chitwan abstract abnormal uterine bleeding is a common morbid condition of woman seeking medical advice.
The worldwide impact of abnormal uterine bleeding aub in the reproductiveyears is substantial,with a prevalenceof approximately 3%30% among reproductiveaged women. Review what is normal bleeding and what is not normal. This type of bleeding may include spotting of small amounts of blood between periods often seen on toilet tissue after wiping or extremely heavy periods in which you soak a pad or tampon every one to two hours for two or more hours. Algorithm for work up of postmenopausal bleeding 7 introduction postmenopausal bleeding pmb refers to an episode of bleeding in a woman who had her final menstrual period 12 or more months ago. Chronic heavy or prolonged uterine bleeding can result in anemia, interfere with daily activities, and raise concerns about uterine cancer. The medical management of abnormal uterine bleeding in. One third of outpatient visits to the gynecologist are for aub, and it accounts for more than 70% of all gyne. Abnormal uterine bleeding marquette general hospital. An overview of postmenopausal bleeding by marinelle platonjones, do, gigi kwok, md, and jennifer keehbauch, md 1 figure 1. The american college of obstetricians and gynecologists has issued new guidelines for managing excessive or irregular bleeding caused by.
A common and often debilitating condition, affecting women of reproductive age. A normal menstrual period generally lasts up to 8 days. Abnormal uterine bleeding in the adolescent patient. Acog releases guidelines on management of abnormal uterine. Evaluation and management of abnormal uterine bleeding in premenopausal women. Treatment options for dysfunctional uterine bleeding. Our new crystalgraphics chart and diagram slides for powerpoint is a collection of over impressively designed datadriven chart and editable diagram s guaranteed to impress any audience. Uterine leiomyomas are very common, with some studies reporting leiomyomas in 70% of white women and more than 80% of black women by age 50 years 2. Bleeding or spotting between periods bleeding or spotting after sex heavy bleeding during your period menstrual cycles that are longer than 38 days or shorter than 24 days irregular periods in which cycle length varies by more than 7. In this document, standard resectoscopic endometrial ablation will be compared with the newer nonresectoscopic endometrial ablation devices and techniques. Abnormal uterine bleeding is a common problem,1 and its management can be complex. Teens typically experience dub during the first 2 years after menarche begins, when their hypothalamicpituitaryadrenal axis hpa axis is immature. Aub is responsible for significant health problem and social embarrassment and it is one of the common reasons women seek health care. Clinical diagnosis of abnormal uterine bleeding was established based on the history provided by the patients.
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 frequency 7 days. Health care practitioners deal with this problem frequently. Abnormal vaginal bleeding is any vaginal bleeding unrelated to normal menstruation. As a result, in ovulatory dysfunctional uterine bleeding, treatment with prostaglandin synthetase inhibitors are more effective than hormonal treatment. Acog practice bulletin 128 on diagnosis of abnormal uterine bleeding in reproductiveaged women 22914421 obstet gynecol 2012 jul. Patient resources gynaecologist windsor, berkshire.
Abnormal uterine bleeding related to ovulatory dysfunction i. Abnormal uterine bleeding dysfunctional uterine bleeding ncbi. Abnormal uterine bleeding aub is a common problem among nonpregnant women in the reproductive age. Management of abnormal uterine bleeding wesley obgyn. Dec 07, 2018 dysfunctional uterine bleeding dub is irregular uterine bleeding that occurs in the absence of pathology or medical illness. Blood samples were collected on the next day or on the same day if patients were fasting. Being one of the common gynecological problems we did this study to find out the hospital prevalence, causes and management at chitwan medical college.
Formerly, it was known as dysfunctional uterine bleeding dub. Abnormal uterine bleeding in young girls bleeding before menarche the first period in a girls life is always abnormal. Approach to abnormal uterine bleeding in nonpregnant reproductive. Bleeding in any of the following situations is considered abnormal uterine bleeding. Abnormal uterine bleeding aub in nonpregnant women is a common problem. With a focus on common patient questions and concerns, topics include. Abnormal uterine bleeding is bleeding that is different from a womans normal menstrual cycle, unrelated to menstruation, or unusual for her age. The two figo systems for normal and abnormal uterine. Abnormal uterine bleeding aub, also known as atypical vaginal bleeding, is vaginal bleeding from the uterus that is abnormally frequent, lasts excessively long, is heavier than normal, or is irregular. One third of outpatient visits to the gynecologist are for aub, and it accounts for more than 70% of all gynecologic consults in.
Howeve r, there are rare hormonal conditions that cause abnormal uterine bleeding in ovulatory cycles. Abnormal dysfunctional uterine bleeding medication. It accounts for approximately 5 percent of office gynecology visits. About onethird of all women experience abnormal uterine bleeding aub sometime during their lifetime and aub can impair quality of life. Abnormal uterine bleeding is a common condition, with a prevalence of 10% to 30% among women of reproductive age. Abnormal uterine bleeding associated with ovulatory dysfunction aubo is a condition for which women frequently seek gynecologic care. Once a woman who is not taking hormone therapy enters menopause and the menstrual cycles have ended, any uterine bleeding is considered abnormal. Abnormal uterine bleeding has various definitions and. Medical management of abnormal uterine bleeding in.
Prolactin level in women with abnormal uterine bleeding. 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. Abnormal uterine bleeding aub is a common clinical problem, affecting up to 14% of women during their reproductive years and impairing their quality of life by creating significant physical, emotional, sexual, social, and financial burdens. The panel concluded that after a diagnostic workup has excluded structural and endometrial pathology, medical therapy is the preferred firstline treatment for uterine bleeding associated with. Heavy menstrual bleeding hmb is the most frequent clinical. Introduction abnormal uterine bleeding aub is a common problem among women in the reproductive age. Jun 26, 20 updated patient management guidelines for the treatment of patients with abnormal uterine bleeding associated with ovulatory dysfunction have been released in a practice bulletin published in the. Abnormal uterine bleeding aub is the most common gynecologic complaint of adolescents admitted to hospital. Anovulatory uterine bleeding is the primary cause of aub in adolescents and generally resolves with maturation of the hypothalamicpituitaryovarian axis. Abnormal uterine bleeding healthcare baylor college of. The two figo systems for normal and abnormal uterine bleeding symptoms and classification of causes of abnormal uterine bleeding in the reproductive years. 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 aub may be acute or chronic and is defined as. Abnormal uterine bleeding aub is one of the most common reasons adolescent patients present for gynecologic care. The management of perimenopausal abnormal uterine bleeding. Abnormal uterine bleeding national health portal of india.
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