The prevalence of abnormal uterine bleeding among reproductive-aged women internationally is estimated to be between 3% to 30% with a higher incidence occurring around menarche and perimenopause
About
- Differentiate into physiological and pathological causes
Aetiology
- Exclude local pathology
- Vagina, Cervical, Uterine
Causes
- Vulva: Benign growths or malignancy
- Vagina: Benign growths, sexually transmitted infections, vaginitis, malignancy, trauma, foreign bodies
- Cervix: Benign growths, sexually transmitted infections, malignancy
- Fallopian tubes and ovaries: Pelvic inflammatory disease, malignancy
- Urinary tract: Infections, malignancy
- Gastrointestinal tract: Inflammatory bowel disease, Behcet syndrome
- Pregnancy complications: Spontaneous abortion, ectopic pregnancy, placenta previa
- Uterus: Aetiologies of bleeding arising from the uterine corpus are listed in the acronym PALM-COEIN
Uterine bleeding PALM-COEIN
- P: Polyp
- A: Adenomyosis
- L: Leiomyoma
- M: Malignancy and hyperplasia
- C: Coagulopathy
- O: Ovulatory dysfunction
- E: Endometrial disorders
- I:- Iatrogenic
- N: Not otherwise classified
Clinical
- PV bleeding - assess frequency and amount
- Weight pads, count pads
- Bleeding or spotting between periods.
- Bleeding or spotting after sex.
- Period lasting > 7 days
- Heavy bleeding during your period
Differentials
Investigations
- Is the patient pregnant - send pregnancy test
- FBC: iron deficiency anaemia, U&E, CRP.
- Check coagulation: some have von Willebrand disease and others may have an underlying coagulation disorder
- Pregnancy test in all fertile females
- Transvaginal ultrasound (TVUS) and report to include endometrial thickness
- Diagnostic hysteroscopy is a highly
specific, accurate, safe and clinically useful
tool for detecting intrauterine abnormalities
and to direct treatment at the specific
pathology while avoiding
unnecessary surgery.
- Postmenopausal patients need a pelvic ultrasound and/or endometrial biopsy
Management
- ABCDE and acute management when needed. Admit if heavy bleeding and may need a transfusion
- Consider TVUS and if abnormal then Refer to the gynaecologist for endometrial biopsy (with or without hysteroscopy).
An appointment should ideally be within 6 weeks of referral
- Treat any coagulopathy
- Hormonal management is considered the first line of medical therapy for patients with acute AUB without known or suspected bleeding disorders.
- Tranexamic acid 1g TDS
References