Abnormal Uterine Bleeding

The nomenclature that exists in the literature relating to Abnormal uterine Bleeding ( AUB ) is confusing and has often times been inconsistently applied.This has hampered evidence based evaluation and interpretation of results given the various therapeutic options.

To address this, the International Federation Of Gynaecology and Obstetrics (FIGO ) proposed and published in 2011 a revised nomenclature. It was envisioned that the most straightforward part of this system would be used at a primary care level and that the sub classifications would me more relevant at Specialist and research levels.

Under this new classification system, which takes into account the causation of AUB, previously loosely used terminologies such as, menorrhagia, metrorrhagia, menometrorrhagia, polymenorrhoea and dysfunctional uterine bleeding (DUB) have been discarded.

The term AUB is not restricted to menstrual bleeding that is abnormally heavy, but also abnormal in timing. Thus Heavy Menstrual Bleeding (HMB) may coexist with Inter Menstrual Bleeding (IMB) or they may present as two distinct entities.

The FIGO classification for AUB based on causation falls into 9 main categories, conveniently represented by the acronym PALM COEIN.

Polyp AUB-P Coagulopathy AUB-C
Adenomyosis AUB-A Ovalutory dysfunction AUB-O
Leiomyoma AUB-L Endometrial AUB-E
Malignancy AUB-M latrogenic AUB-I
Not Yet Classified AUB-N

AUB may be acute or chronic. Chronic AUB would be defined as bleeding from the uterine corpus that is abnormal in volume, regularity or timing and been present for the majority of the past six months. Acute AUB is an episode of heavy bleeding that in the opinion of the clinician, is of sufficient quantity to require immediate intervention to prevent further blood loss.

For clinical purposes, HMB should be defined as excessive menstrual blood loss which interferes with the womans physical , emotional, social and material quality of life, which may occur alone or in conjunction with other symptoms.

Given this understanding of nomenclature and classification system, this presentation will attempt to provide an overview and guidance on the evaluation and management of patients presenting with AUB in the primary care setting. The more specific and common pathologic causes of AUB will be addressed, including an update on current medical and surgical therapeutic options.