AUB

Bethelhem Berhanu

DefinitionsSignificance.Classifications

Definition

• Any deviation in normal frequency, duration amount of menstruation

Normal??28 ± 71-8 (3-5)10-80ml

(30-50)

Can also include vaginal bleeding before menarche and after menopause

• Menorrhagia: Excessive (>80 ml) & / or prolonged menstruation(>7), at regular intervals

• Metrorrhagia - Irregular, frequent bleeding of varying amounts but not excessive

• Menometrorrhagia Prolonged or excessive bleeding at irregular intervals

• Polymenorrhea Regular bleeding at intervals of less than 21 days

• Oligomenorrhea Bleeding at intervals greater than 35 days – may be irregular

• Intermenstrual Uterine bleeding between regular cycles

Definitions contd

Others…• Hypermenorrhea – similar to menorrhagia but

usually refers to heavy mensus (in terms of amount)

• Hypomenorrhea (cryptomenorrhea) – regular scanty bleeding – Could be due to anatomic or hormonal

abnormalities• Anatomic – imperforated hymen, incomplete transverse

vaginal septum, cervical or vaginal stenosis, asherman’s syndrome.

• Hormonal – hypothyroidism, hyperprolactinemia, hyperinsulinemia

• Contact bleeding – post coital or post examination bleeding. 2/3 – unknown causesCervicitis or vaginitis – e.g. – Chlamydia, trichomonas Cervical caCervical polypsCervical eversionAtrophic vaginitis

• METROTAXIS: continuous uterine bleeding without interruption

• Amenorrhea – no mensus for 6 months

cervical cancer unless R/O

Novak’s gynaecology 14th edition

Why do we have to know about AUB??

• Abnormal uterine bleeding affects 10 to 30 percent of reproductive-aged women and up to 50 percent of perimenopausal women

• It is a common reason for gynecologic consultation.

• Responsible for over one third of hysterectomies.

Classification of AUBChildhood

• Mostly vaginal – vulvovaginitis, trauma, neoplasms, precosious puberty

Adolescence

• DUB – anovulation mostly…., sexual abuse, STDs

Child bearing age – r/o pregnancy

• Pregnancy related, STDs, myomas. Etc.

Peri menopausal

• DUB

Post menopausal - r/o malignancies

• Tumors, atrophy

Classification of causes

Classifications contd. AUB

Non- Obstetric

Non- gynaecologic

Systemic

Local

Gynaecologic

Obstetric

AbortionEctopic pregnancyGTDImplantation bleeding

LieomyomaAdenomyosisPolypsTumorsInfectionsTrauma

EndocrinopathiesCoagulopathiesHepatic and renal failureDUB

Urethral bleedingRectal bleeding

Gynecologic causes - uterus

• Uterine fibroids – especially submucous type. – Higher surface area– Venous congestion– Dysregulation of local vasoactive growth factors– Interfere with myometrial contractility

• Adenomyosis – also called ‘endometriosis interna’, refers to ectopic endometrial tissue within the myometrium – possibly results from increased and abnormal vascularization

of the endometrial lining– Is also associated with dysmenorrhea

Gyn. Contd.

• Endometrial polyps – are also associated with AUB possibly due to asynchronous shedding to that of the normal endometrium– Thus usually associated with intermenustrial bleeding.

• Endometrial hyperplasia and cancer – Endometrial cancer should be suspected in any woman in

menopausal transition with abnormal uterine bleedingTwo thirds of women with endometrial cancer present with

postmenopausal bleedingOnly about 5% of endometrial ca occurs in patients younger

than 40 yrs

Gyn. Contd.

• Other uterine lesions include:– Atrophic endometrium– Infections – STD, TB– Mechanical causes – e.g. - IUD– Arteriovenous malformation

Non uterine gyn, causes

• Ovary - ???• Fallopian tube – salphingitis, Cancer• Cervix – Cancer, polyps, Infections• Vagina – Cancer, infections, atrophic vaginitis,

foreinbody, Trauma

Systemic causes…

• Endocrinopathies – Hypo or hyperthyroidism, hyperprolactinemia, adrenal disorders, DM

• Coagulopathies – Factor deficiency – von willebrand’s disease,

hemophilia– Palate disorders – ITP, leukemia, aplastic anemia

etc.

• Hepatic and renal failure – deficiency due to decreased synthesis and increased loss respectively

What is the most

common cause of AUB???

DUB(50%)

References

• Williams Gynecology • Berek & Novak's Gynecology, 14th Edition• Danforth's Obstetrics and Gynecology, 9th Ed• Wikipedia• www.figo.com• www.acog.com• www.slideshare.com