Abnormal Uterine Bleeding

  • Tricia A. Murdock
  • Emanuela F. T. Veras
  • Robert J. Kurman
  • Michael T. Mazur


This chapter specifically addresses uterine bleeding resulting from alterations in the normal cyclical changes of the endometrium that are not due to structural causes. It is termed “abnormal uterine bleeding” (AUB); in the past AUB was referred to as “dysfunctional uterine bleeding” (DUB) (Fritz and Speroff, Abnormal uterine bleeding. In: Clinical gynecologic endocrinology and infertility, 8th edn. Lippincott Williams & Wilkins, Philadelphia, 2010, pp 591–620; Bayer and DeCherney, JAMA 269:1823–1828, 1993; Galle and McRae. JAMA 93:73–6, 80–81, 1993; Vakiani et al., Clin Exp Obstet Gynecol 23:236–239, 1996; Ryntz and Lobo, Abnormal uterine bleeding. In: Lobo RA, Gershenson DM, Lentz GM, Valea FA (eds) Comprehensive gynecology, 7th edn. Elsevier, Philadelphia, 2017, pp 621–633). Clinically, this type of bleeding is addressed in the acronym COEIN (coagulopathy, ovulatory dysfunction, endometrial, iatrogenic, and not yet classified) (see Chap.  1). Abnormal uterine bleeding, therefore, excludes postmenopausal bleeding or bleeding caused by the presence of specific pathologic processes such as inflammation, polyps, hyperplasia, carcinoma, exogenous hormones, and complications of pregnancy. It is important to recognize the endometrial changes associated with nonstructural AUB, because they may be confused with more serious lesions such as hyperplasia or carcinoma. The most common morphologic change associated with this type of bleeding is endometrial glandular and stromal breakdown. Glandular and stromal breakdown can be found in a variety of organic disorders, as well. Conversely, not all biopsy specimens of patients with a history of bleeding show evidence of breakdown. Nonetheless, endometrial breakdown and bleeding is commonly encountered, and the morphologic features of bleeding need to be recognized to allow clear separation of these nonspecific artifacts and degenerative/regenerative changes, from other, more specific histologic changes associated with hyperplasia or carcinoma.


Abnormal uterine bleeding Estrogen-related bleeding Progesterone-related bleeding Uterine bleeding Glandular and stromal breakdown 


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Tricia A. Murdock
    • 1
  • Emanuela F. T. Veras
    • 1
  • Robert J. Kurman
    • 1
  • Michael T. Mazur
    • 2
  1. 1.Department of PathologyThe Johns Hopkins HospitalBaltimoreUSA
  2. 2.Department of Pathology and Laboratory MedicineState University of New York Upstate Medical UniversitySyracuseUSA

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