Abnormal uterine bleeding and uterine fibroids page 1 of 19. Laparoscopic ultrasoundguided radiofrequency ablation e. Abnormal uterine bleeding is a common condition, with a prevalence of 10% to 30% among women of reproductive age. A pregnancy that implants outside of the uterus, usually in the fallopian tube. Women with fibroids can have surgical treatment of their fibroids, either by removing the fibroids eg, myomectomy or by reducing the blood supply of the fibroids eg, uterine artery embolization. Abnormal uterine bleeding is a common condition, with a prevalence of 10% to 30% among women of reproduc tive age. Management of abnormal uterine bleeding in reproductive. Heavy menstrual bleeding is the commonest cause of irondeficiency anaemia in the western world. This chapter examines the modes of presentation and the causes of such symptoms, which range from physiological variations to more sinister underlying pathology. 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. Otherwise, treatment is based on the cause, the amount of bleeding and the womans reproductive goals.
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. Abnormal uterine bleeding previously, dysfunctional uterine bleeding dub is irregular uterine bleeding that happens in the absence of recognizable pelvic pathology, basic medical disease, or pregnancy. Most plan documents provide coverage for unproven services for a lifethreatening sickness or condition, at our. Dub is typically characterized by heavy prolonged flow with or without breakthrough bleeding. Abnormal uterine bleeding affects up to 50% of perimenopausal women, and dub in these women is most likely caused by a decline in ovarian function. Defining abnormal uterine bleeding aub normal menstrual cycle frequency 25 days. Abnormal uterine bleeding british medical bulletin. Abnormal uterine bleeding aub is defined as changes in frequency of menses, duration of flow or amount of blood loss. These women may have too much estrogen or not enough progesterone.
In cases of acute and severe bleeding, women may need urgent treatment with. One national study found that menstrual disorders were the reason for 19. Abnormal uterine bleeding is a common problem encountered in general practice. In many women, a hormone imbalance causes bleeding. Clinical practice clinical update d ysfunctional uterine bleeding dub is defined as excessively heavy, prolonged or frequent bleeding of uterine origin that is not due to pregnancy or any recognisable pelvic or systemic disease. Anovulatory or dysfunctional uterine bleeding dub dysfunctional uterine bleeding is the occurrence of uterine bleeding unrelated to structural abnormalities of the uterus or the endometrial lining. Prevalence of abnormal uterine bleeding according to new. Health care practitioners deal with this problem frequently.
Management of abnormal uterine bleeding 3 treatment could be initiated in a primary care setting or in 1. Primary care management of abnormal uterine bleeding aub. Cancer of the uterus and infection of the cervix are other causes of bleeding. Dysfunctional uterine bleeding dub, the most common cause of abnormal uterine bleeding, occurs most often in women 45 50% of cases and in adolescents 20% of cases. In the general population, abnormal uterine bleeding is estimated to affect 11 to percent of reproductive age women at any given time. Aub may be accompanied by pain and discomfort, cause significant social embarrassment, and have a substantial effect on healthrelated quality of life. If the cause of dysfunctional uterine bleeding is another medical condition, treating that condition should restore normal cycles. The medical management of abnormal uterine bleeding in.
Aub is regarded as a sign of possible uterine disease, including acute and chronic aub. Abnormal uterine bleeding is a common problem,1 and its management can be complex. When hormones are the problem, doctors call the problem dysfunctional uterine bleeding, or dub. 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. It reflects an interruption in the normal cyclic pattern of ovulatory hormonal stimulation to the endometrial lining. Once the likely cause of abnormal bleeding is identified, appropriate treatment should be instituted. 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. Normal menstruation can range from a frequency of between 24 and 38 days, a duration between 4. Cer 96 primary care management of abnormal uterine. Abnormal uterine bleeding aub is a common problem among women in the reproductive age. A common and often debilitating condition, affecting women of reproductive age. We focused on interventions that are suitable for use in primary care practice including medical, behavioral, and complementary and alternative medicine approaches. Dysfunctional uterine bleeding is basically abnormal vaginal bleeding in the reproductive years of a woman. Management of abnormal uterine bleeding in reproductive period.
A classification of abnormal uterine bleeding is presented in table 102. Know the types, causes, symptoms, treatment and diagnosis of dysfunctional uterine bleeding. Abnormal uterine bleeding aub is a condition that affects approximately 30% of women during their reproductive years. Problem bleeding is among the most common gynecologic complaints of reproductive age women in ambulatory care settingsof similar frequency to the number seeking care for urinary tract infections and vaginitis. Dysfunctional uterine bleeding dub is a diagnosis of exclusion when there is no pelvic pathology or underlying medical cause. In most women, abnormal uterine bleeding is caused by a hormone imbalance. Treatment of abnormal uterine bleeding and fibroids 2019.
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. The volume of menstrual flow is influenced in part by uterine contractions, vascular tone and haemostatic function. Aub is a common reason for referral to a gynecologist, and 5 percent of women between the ages of 30 and 49 years consult a clinician for evaluation of menorrhagia 46. Abnormal uterine bleeding is an extremely common indication for referral to a gynaecologist. It is a difficult condition for the woman, mentally as well as socially and also financially.
The mechanisms for the abnormal bleeding and the site from which it. Patients with ovulatory abnormal bleeding should be evaluated for intracavitary uterine pathology, since hormonal dysfunction is probably not the cause. M enstrual bleeding is considered normal when it occurs regularly every 25 days, lasts 4 to 8 days, and is not associated with heavy bleeding. For anovulatory cycles, medical therapy with ocs or progesterone is the standard. Abnormal exam, suspect pathology such as polypsadenomyosis endometrial stripe only in pmb endometrial biopsy. Of these, approximately 20% are performed in women with a normal uterine size. Abnormal bleeding caused by hormone imbalance is more common in teenagers or in women who are approaching menopause. Clinical practice clinical update dysfunctional uterine. It may impact physical, emotional sexual and professional aspects of the lives of women, impairing their quality of life. Guidelines for the management of abnormal uterine bleeding. Abnormal uterine bleeding aub is the most common symptom of gynecological conditions, which is defined as any type of bleeding in which the duration, frequency, or amount is excessive for an individual patient.
Chronic heavy or prolonged uterine bleeding can result in anemia, interfere with daily activities, and raise concerns about uterine cancer. Severe acute bleeding irregular bleeding menorrhagia secondary amenorrhea pregnant figure 3 figure 4 figure 5 figure 6 figure 2 any abnormal pattern associated with certain. Abnormal uterine bleeding murtaghs general practice, 7e. The most definitive surgical treatment for abnormal uterine bleeding is hysterectomy, or removal of the entire uterus. A systematic approach to chronic abnormal uterine bleeding. It is the most common symptom and main complaint among. As a result, in ovulatory dysfunctional uterine bleeding, treatment with prostaglandin synthetase inhibitors are more effective than hormonal treatment. Abnormal uterine bleeding etiology bmj best practice. 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. Endometrial ablation in the management of abnormal uterine. Half of all hysterectomies in the united states are performed to treat abnormal uterine bleeding.
It is a diagnosis of exclusion made after structural causes of bleeding and chronic medical diseases have been ruled out. Abnormal uterine bleeding with no evidence of mechanical or structural cause. Howeve r, there are rare hormonal conditions that cause abnormal uterine bleeding in ovulatory cycles. Treatment options for dysfunctional uterine bleeding. Polyps or fibroids small and large growths in the uterus can also cause bleeding. Abnormal uterine bleeding has various definitions and. This document reflects emerging clinical and scientific advances on the date issued and is subject to change.