Skip to main content
SpringerLink
Log in

Abnormal Uterine Bleeding

  • Chapter
  • First Online:
Clinical Reproductive Medicine and Surgery

  • 2002 Accesses

Abstract

Abnormal uterine bleeding (AUB) is the primary reason for one-third of all gynecology visits and more than half of all hysterectomies. After excluding pregnancy, the basic evaluation consists of a thorough history and physical examination, anatomic assessment by ultrasound, laboratory evaluation, and, often, endometrial biopsy. Irregular cycles are commonly due to anovulation resulting from polycystic ovary syndrome, but other causes and coexisting conditions must be excluded. Medical management will significantly improve or resolve symptoms in many women and can include hormonal therapy, nonsteroidal antiinflammatory drugs, or tranexamic acid. When AUB does not respond to standard hormonal therapies, antibiotic treatment of subclinical endometritis can be considered. Surgical approaches remain important options for both evaluation and treatment of AUB.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 159.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 209.00
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Coulter A, Bradlow J, Agass M, Martin-Bates C, Tulloch A. Outcomes of referrals to gynaecology outpatient clinics for menstrual problems: an audit of general practice records. Br J Obstet Gynaecol. 1991;98:789–96.

    Article  PubMed  CAS  Google Scholar 

  2. Carlson KJ, Nichols DH, Schiff I. Indications for hysterectomy. N Engl J Med. 1993;328:856–60.

    Article  PubMed  CAS  Google Scholar 

  3. Munro MG, Critchley HO, Broder MS, Fraser IS, FIGO Working Group on Menstrual Disorders. FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age. Int J Gynaecol Obstet. 2011;113(1):3–13.

    Article  PubMed  Google Scholar 

  4. Fraser IS. Menorrhagia–a pragmatic approach to the understanding of causes and the need for investigations. Br J Obstet Gynaecol. 1994;101 Suppl 11Suppl 11:3–7.

    PubMed  Google Scholar 

  5. Bayer SR, DeCherney AH. Clinical manifestations and treatment of dysfunctional uterine bleeding. JAMA. 1993;269(14):1823–8.

    Article  PubMed  CAS  Google Scholar 

  6. Fraser IS, Critchley HO, Munro MG, Broder M, Writing Group for this Menstrual Agreement Process. A process designed to lead to international agreement on terminologies and definitions used to describe abnormalities of menstrual bleeding. Fertil Steril. 2007; 87(3):466–76.

    Article  PubMed  Google Scholar 

  7. Falco P, Zagonari S, Gabrielli S, Bevini M, Pilu G, Bovicelli L. Sonography of pregnancies with first-trimester bleeding and a small intrauterine gestational sac without a demonstrable embryo. Ultrasound Obstet Gynecol. 2003;21(1):62–5.

    Article  PubMed  CAS  Google Scholar 

  8. Barnhart K, Esposito M, Coutifaris C. An update on the medical treatment of ectopic pregnancy. Obstet Gynecol Clin North Am. 2000;27:653–67.

    Article  PubMed  CAS  Google Scholar 

  9. Soto-Wright V, Bernstein M, Goldstein DP, Berkowitz RS. The changing clinical presentation of complete molar pregnancy. Obstet Gynecol. 1995;86(5):775–9.

    Article  PubMed  CAS  Google Scholar 

  10. Eschenbach DA. Acute pelvic inflammatory disease: etiology, risk factors and pathogenesis. Clin Obstet Gynecol. 1976;19(1): 147–69.

    Article  PubMed  CAS  Google Scholar 

  11. Heatley MK. The association between clinical and pathological features in histologically identified chronic endometritis. J Obstet Gynaecol. 2004;24(7):801–3.

    Article  PubMed  CAS  Google Scholar 

  12. Eckert LO, Thwin SS, Hillier SL, Kiviat NB, Eschenbach DA. The antimicrobial treatment of subacute endometritis: a proof of concept study. Am J Obstet Gynecol. 2004;190(2):305–13.

    Article  PubMed  CAS  Google Scholar 

  13. Gotz HM, van Bergen JE, Veldhuijzen IK, Broer J, Hoebe CJ, Richardus JH. A prediction rule for selective screening of Chlamydia trachomatis infection. Sex Transm Infect. 2005;81(1):24–30.

    Article  PubMed  CAS  Google Scholar 

  14. Marrazzo JM, Handsfield HH, Whittington WL. Predicting chlamydial and gonococcal cervical infection: implications for management of cervicitis. Obstet Gynecol. 2002;100(3):579–84.

    Article  PubMed  Google Scholar 

  15. Jones H. Clinical pathway for evaluating women with abnormal uterine bleeding. Obstet Gynecol Surv. 2002;57:22–4.

    Article  Google Scholar 

  16. Day Baird D, Dunson DB, Hill MC, Cousins D, Schectman JM. High cumulative incidence of uterine leiomyoma in black and white women: ultrasound evidence. Am J Obstet Gynecol. 2003;188: 100–7.

    Article  Google Scholar 

  17. Bazot M, Cortez A, Darai E, Rouger J, Chopier J, Antoine JM, et al. Ultrasonography compared with magnetic resonance imaging for the diagnosis of adenomyosis: correlation with histopathology. Hum Reprod. 2001;16:2427–33.

    PubMed  CAS  Google Scholar 

  18. Nathani F, Clark TJ. Uterine polypectomy in the management of abnormal uterine bleeding: a systematic review. J Minim Invasive Gynecol. 2006;13(4):260–8.

    Article  PubMed  Google Scholar 

  19. Clevenger-Hoeft M, Syrop CH, Stovall DW, Van Voorhis BJ. Sonohysterography in premenopausal women with and without abnormal bleeding. Obstet Gynecol. 1999;94:516.

    Article  PubMed  CAS  Google Scholar 

  20. Armstrong AJ, Hurd WW, Shaker ME, Elguero SB, Barker NG, Zanotti KM. Diagnosis and management of endometrial hyperplasia. J Minim Invasive Gynecol. 2012;19(5):562–71.

    Article  PubMed  Google Scholar 

  21. Sorosky J. Endometrial cancer. Obstet Gynecol. 2008;112(1): 186–7.

    Article  Google Scholar 

  22. Young RH, Clement PB. Pseudoneoplastic glandular lesions of the uterine cervix. Semin Diagn Pathol. 1991;8(4):234–49.

    PubMed  CAS  Google Scholar 

  23. Rosenthal AN, Panoskaltsis T, Smith T, Soutter WP. The frequency of significant pathology in women attending a general gynaecological service for postcoital bleeding. BJOG. 2001;108(1):103–6.

    PubMed  CAS  Google Scholar 

  24. Krettek JE, Arkin SI, Chaisilwattana P, Monif GR. Chlamydia trachomatis in patients who used oral contraceptives and had intermenstrual spotting. Obstet Gynecol. 1993;81(5):728–31.

    PubMed  CAS  Google Scholar 

  25. Zhang J, Salamonsen LA. In vivo evidence for active matrix metalloproteinases in human endometrium supports their role in tissue breakdown at menstruation. J Clin Endocrinol Metab. 2002;87(5): 2346–51.

    Article  PubMed  CAS  Google Scholar 

  26. Brenner PF. Differential diagnosis of abnormal uterine bleeding. Am J Obstet Gynecol. 1996;175(3 Pt 2):766–9.

    Article  PubMed  CAS  Google Scholar 

  27. Tsilchorozidou T, Overton C, Conway GS. The pathophysiology of polycystic ovary syndrome. Clin Endocrinol (Oxf). 2004;60(1): 1–17.

    Article  CAS  Google Scholar 

  28. Zawadski JK, Dunaif A. Diagnostic criteria for polycystic ovary syndrome: towards a rational approach. Polycystic ovary syndrome. Boston: Blackwell Scientific; 1992. p. 377–84.

    Google Scholar 

  29. Hurd WW, Abdel-Rahman MY, Ismail SA, Abdellah MA, Schmotzer CL, Sood A. Comparison of diabetes mellitus and insulin resistance screening methods for women with polycystic ovary syndrome. Fertil Steril. 2011;96:1043–7.

    Article  PubMed  CAS  Google Scholar 

  30. Pugeat M, Ducluzeau PH. Insulin resistance, polycystic ovary syndrome and metformin. Drugs. 1999;58 Suppl 1Suppl 1:41–6.

    Article  PubMed  CAS  Google Scholar 

  31. Chang RJ. A practical approach to the diagnosis of polycystic ovary syndrome. Am J Obstet Gynecol. 2004;191(3):713–7.

    Article  PubMed  Google Scholar 

  32. Holley JL. The hypothalamic-pituitary axis in men and women with chronic kidney disease. Adv Chronic Kidney Dis. 2004;11(4): 337–41.

    PubMed  Google Scholar 

  33. Falcone T, Desjardins C, Bourque J, Granger L, Hemmings R, Quiros E. Dysfunctional uterine bleeding in adolescents. J Reprod Med. 1994;39:761–4.

    PubMed  CAS  Google Scholar 

  34. Committee ACOG. Opinion no. 451: Von Willebrand disease in women. Obstet Gynecol. 2009;114:1439–43.

    Google Scholar 

  35. Minakuchi K, Hirai K, Kawamura N, Ishiko O, Kanaoka Y, Ogita S. Case of hemorrhagic shock due to hypermenorrhea during anticoagulant therapy. Arch Gynecol Obstet. 2000;264(2):99–100.

    Article  PubMed  CAS  Google Scholar 

  36. Woo YL, White B, Corbally R, Byrne M, O’Connell N, O’Shea E, et al. Von Willebrand’s disease: an important cause of dysfunctional uterine bleeding. Blood Coagul Fibrinolysis. 2002;13(2):89–93.

    Article  PubMed  CAS  Google Scholar 

  37. Kouides PA. Menorrhagia from a haematologist’s point of view. Part I: initial evaluation. Haemophilia. 2002;8(3):330–8.

    Article  PubMed  CAS  Google Scholar 

  38. Sahin Y, Kelestimur F. The frequency of late-onset 21-hydroxylase and 11 beta-hydroxylase deficiency in women with polycystic ovary syndrome. Eur J Endocrinol. 1997;137(6):670–4.

    Article  PubMed  CAS  Google Scholar 

  39. Kouides PA. Evaluation of abnormal bleeding in women. Curr Hematol Rep. 2002;1(1):11–8.

    PubMed  Google Scholar 

  40. Committee on Practice Bulletins—Gynecology. Practice bulletin no. 128: diagnosis of abnormal uterine bleeding in reproductive-aged women. Obstet Gynecol. 2012;120(1):197–206.

    Article  Google Scholar 

  41. DeVore GR, Owens O, Kase N. Use of intravenous premarin in the treatment of dysfunctional uterine bleeding—a double-blind randomized control study. Obstet Gynecol. 1982;59:285.

    PubMed  CAS  Google Scholar 

  42. Hestinger M, Stockenhuber F, Schneider B, Pabinger I, Brenner B, Wagner B, et al. Effect of conjugated estrogens on platelet function and prostacyclin generation in CRF. Kidney Int. 1990;38:1181.

    Article  Google Scholar 

  43. Zreik TG, Odunsi K, Cass I, Olive DL, Sarrel P. A case of fatal pulmonary thromboembolism associated with the use of intravenous estrogen therapy. Fertil Steril. 1999;71(2):373–5.

    Article  PubMed  CAS  Google Scholar 

  44. Tepper N, Curtis KM, Jamieson DJ, Marchbanks PA, Centers for Disease Control and Prevention (CDC). Update to CDC’s U.S. medical eligibility criteria for contraceptive use, 2010: revised recommendations for the use of contraceptive methods during the postpartum period. Morb Mortal Wkly Rep. 2011;60:878–83.

    Google Scholar 

  45. Ferenczy A. Pathophysiology of endometrial bleeding. Maturitas. 2003;45(1):1–14.

    Article  PubMed  CAS  Google Scholar 

  46. Larsson PG, Bergman B, Forsum U, Pahlson C. Treatment of bacterial vaginosis in women with vaginal bleeding complications or discharge and harboring Mobiluncus. Gynecol Obstet Invest. 1990;29(4):296–300.

    Article  PubMed  CAS  Google Scholar 

  47. Moller BR, Kristiansen FV, Thorsen P, Mogensen SC. Sterility of the uterine cavity. Acta Obstet Gynecol Scand. 1995;74:216–9.

    Article  PubMed  CAS  Google Scholar 

  48. Legro RS, Barnhart HX, Schlaff WD, Carr BR, Diamond MP, Carson SA, et al. Clomiphene, metformin, or both for infertility in the polycystic ovary syndrome. N Engl J Med. 2007;356(6): 551–66.

    Article  PubMed  CAS  Google Scholar 

  49. Sulak PJ. The career woman and oral contraceptive use. Int J Fertil. 1991;36(Suppl2):90–7.

    PubMed  Google Scholar 

  50. Sulak PJ, Cressman BE, Waldrop E, Holleman S, Kuehl TJ. Extending the duration of active oral contraceptive pills to manage hormone withdrawal symptoms. Obstet Gynecol. 1997;89(2):179–83.

    Article  PubMed  CAS  Google Scholar 

  51. Anderson FD, Hait H. A multicenter, randomized study of an extended cycle oral contraceptive. Contraception. 2003;68:89–96.

    Article  PubMed  CAS  Google Scholar 

  52. Lethaby A, Irvine G, Cameron I. Cyclical progestogens for heavy menstrual bleeding. Cochrane Database Syst Rev. 2008;(1):CD001016.

    Google Scholar 

  53. Hurskainen R, Teperi J, Rissanen P, Aalto AM, Grenman S, Kivelä A, et al. Clinical outcomes and costs with the levonorgestrel-releasing intrauterine system or hysterectomy for treatment of menorrhagia; randomized trial 5 year follow up. JAMA. 2004;291:1456–63.

    Article  PubMed  CAS  Google Scholar 

  54. Hidalgo M, Bahamondes L, Perrotti M, Diaz J, Dantas-Monteiro C, Petta C. Bleeding patterns and clinical performance of the levonorgestrel-releasing intrauterine system (Mirena) up to two years. Contraception. 2002;65(2):129–32.

    Article  PubMed  CAS  Google Scholar 

  55. Nilsson CG, Lahteenmaki PL, Luukkainen T, Robertson DN. Sustained intrauterine release of levonorgestrel over five years. Fertil Steril. 1986;45(6):805–7.

    PubMed  CAS  Google Scholar 

  56. Cooke I, Lethaby A, Farquhar C. Antifibrinolytics for heavy menstrual bleeding. Cochrane Database Syst Rev. 2000;(2):CD000249.

    Google Scholar 

  57. Fraser IS, Porte RJ, Kouides PA, Lukes AS. A benefit-risk review of systemic haemostatic agents: part 2: in excessive or heavy menstrual bleeding. Drug Saf. 2008;31(4):275–82.

    Article  PubMed  CAS  Google Scholar 

  58. Speroff L, Fritz MA. Clinical gynecologic endocrinology and infertility. 7th ed. Philadelphia: Lippincott Williams & Wilkins; 2005.

    Google Scholar 

  59. Lethaby A, Augood C, Duckitt K, Farquhar C. Nonsteroidal anti-inflammatory drugs for heavy menstrual bleeding. Cochrane Database Syst Rev. 2007;(4):CD000400.

    Google Scholar 

  60. ACOG Committee on Practice Bulletins—Gynecology. ACOG practice bulletin no. 81: endometrial ablation. Obstet Gynecol. 2007;109:1233–48.

    Article  Google Scholar 

  61. Lethaby A, Shepperd S, Cooke I, Farquhar C. Endometrial resection and ablation versus hysterectomy for heavy menstrual bleeding. Cochrane Database Syst Rev. 2000;(2):CD000329.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Reproductive Endocrinology and Infertility, University Hospitals Case Medical Center, Shaker Heights, OH, USA

    Sonia Elguero MD

  2. Department of Obstetrics and Gynecology, University Hospitals, Case Western Reserve University School of Medicine, Cleveland, OH, USA

    Justin R. Lappen MD

  3. Department of Obstetrics and Gynecology, Duke University Medical Center, Duke University School of Medicine, Durham, NC, 27705, USA

    William W. Hurd MD, MSc, MPH

Authors
  1. Sonia Elguero MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Justin R. Lappen MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. William W. Hurd MD, MSc, MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to William W. Hurd MD, MSc, MPH .

Editor information

Editors and Affiliations

  1. Cleveland Clinic, Ob/Gyn & Women's Health Institute, Euclid Ave 9500, Cleveland, 44195, Ohio, USA

    Tommaso Falcone

  2. Duke University Medical Center, Duke University School of Medicine, Department of Obstetrics and Gynecology, Erwin Rd 2301, Durham, 27705, North Carolina, USA

    William W. Hurd

Rights and permissions

Reprints and permissions

Copyright information

© 2013 Springer Science+Business Media New York

About this chapter

Cite this chapter

Elguero, S., Lappen, J.R., Hurd, W.W. (2013). Abnormal Uterine Bleeding. In: Falcone, T., Hurd, W. (eds) Clinical Reproductive Medicine and Surgery. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-6837-0_9

Download citation

  • DOI: https://doi.org/10.1007/978-1-4614-6837-0_9

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4614-6836-3

  • Online ISBN: 978-1-4614-6837-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation