Skip to main content

Clinical Evaluation of Abnormal Uterine Bleeding

  • Chapter
  • 1253 Accesses

Abstract

Abnormal uterine bleeding is one of the most common problems a woman faces in her reproductive life span, and it accounts for 20 % of visits to the gynecologic clinic. Abnormal uterine bleeding (AUB) is defined as “bleeding from the uterine corpus that is abnormal in regularity, volume, frequency or duration” and accounts for 25 % of all gynecologic procedures [1]. All clinicians dealing with a case of abnormal uterine bleeding face the basic challenge of excluding any genital tract malignancy by formulating a well-organized and logical approach for evaluation of the symptom. Abnormal uterine bleeding is caused by the disruption of normal physiology, anatomical changes in the endometrium, or endometrial malignancy; therefore, the role of detailed history and clinical examination of the pelvis, besides endometrial sampling and imaging studies, forms the backbone of evaluating this condition.

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

Buying options

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   149.00
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD   109.99
Price excludes VAT (USA)
  • Durable hardcover 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

Learn about institutional subscriptions

References

  1. Goldstein SR. Menorrhagia and abnormal uterine bleeding before the menopause. Best Pract Res Clin Obstet Gynaecol. 2004;18(1):59–69.

    Article  PubMed  Google Scholar 

  2. Munroe MG, Critchley HO, Broder MS, Fraser IS. Causes of abnormal uterine bleeding in nongravid women of reproductive age. FIGO working group on menstrual disorders. Int J Gynaecol Obstet. 2011;113:3–13.

    Article  Google Scholar 

  3. Corbacioqlu Esmer A, Akbavir O, Goksedef BP, Gunduz N, Kisacik S, Daqdeviren H, et al. Is there an appropriate cut off age for sampling the endometrium in premenopausal bleeding? Gynecol Obstet Invest. 2014;77(1):40–4.

    Article  Google Scholar 

  4. ACOG Committee on Practice Bulletins – Gynecology, American College of Obstetricians and Gynecologists. ACOG practice bulletin: management of anovulatory bleeding. Int J Gynaecol Obstet. 2001;72(3):263–71.

    Article  Google Scholar 

  5. Ash SJ, Farrell SA, Flowerdew G. Endometrial biopsy in DUB. J Reprod Med. 1996;41(12):892–6.

    CAS  PubMed  Google Scholar 

  6. Sorosky JI. Endometrial cancer. Obstet Gynecol. 2008;111(2 pt 1):436–47.

    Article  PubMed  Google Scholar 

  7. Farquhar CM, Lethaby A, Sowter M, Verry J, Baranyai J. An evaluation of risk factors for endometrial hyperplasia in premenopausal women with abnormal menstrual bleeding. Am J Obstet Gynecol. 1999;181(3):525–9.

    Article  CAS  PubMed  Google Scholar 

  8. 44 NCG. Heavy menstrual bleeding. London: National Institute for Health and Clinical Excellence; 2007.

    Google Scholar 

  9. Critchley HO, Warner P, Lee AJ, Brechin S, Guise J, Graham B. Evaluation of abnormal uterine bleeding: comparison of three outpatient procedures within cohorts defined by age and menopausal status. Health Technol Assess. 2004;8(34):iii–iv, 1–139.

    Article  CAS  PubMed  Google Scholar 

  10. Dijkhuizen FP, Mol BW, Brölmann HA, Heintz AP. The accuracy of endometrial sampling in the diagnosis of patients with endometrial carcinoma and hyperplasia: a meta-analysis. Cancer. 2000;89(8):1765–72.

    Article  CAS  PubMed  Google Scholar 

  11. ACOG Committee opinion. Role of transvaginal scan in the evaluation of postmenopausal bleeding. Number 440, Aug 2009.

    Google Scholar 

  12. Fritz MA, Speroff L. Clinical gynaecologic endocrinology and infertility. 8th ed. Wolters Kluwer/LWW. 2010; p. 605.

    Google Scholar 

  13. de Vries LD, Dijkhuizen FP, Mol BW, Brölmann HA, Moret E, Heintz AP. Comparison of transvaginal sonography, saline infusion sonography, and hysteroscopy in premenopausal women with abnormal uterine bleeding. J Clin Ultrasound. 2000;28(5):217–23.

    Article  PubMed  Google Scholar 

  14. Dueholm M, Forman A, Jensen ML, Laursen H, Kracht P. Transvaginal sonography combined with saline contrast sonohysterography in evaluating the uterine cavity in premenopausal patients with abnormal uterine bleeding. Ultrasound Obstet Gynecol. 2001;18(1):54–61.

    Article  CAS  PubMed  Google Scholar 

  15. Dueholm M, Lundorf E, Hansen ES, Ledertoug S, Olesen F. Evaluation of the uterine cavity with magnetic resonance imaging, transvaginal sonography, hysterosonographic examination, and diagnostic hysteroscopy. Fertil Steril. 2001;76(2):350–7.

    Article  CAS  PubMed  Google Scholar 

  16. Davidson KG, Dubinsky TJ. Ultrasonographic evaluation of the endometrium in postmenopausal bleeding. Radiol Clin North Am. 2003;41(4):769–80.

    Article  PubMed  Google Scholar 

  17. Vuento MH, Pirhonen JP, Makinen JI, Tyrkko JE, Laipalla PJ, Gronroos M, et al. Screening for endometrial cancer in asymptomatic postmenopausal women with conventional and colour Doppler sonography. BJOG. 1999;106:14–20.

    Article  CAS  Google Scholar 

  18. Mathew M, Gowri V, Rizvi SG. Saline infusion sonography-an effective tool for evaluation of endometrial cavity in women with abnormal uterine bleeding. Acta Obstet Gynecol Scand. 2010;89(1):140–2.

    Article  PubMed  Google Scholar 

  19. Moschos E, Ashfaq R, McIntire DD, Liriano B, Twickler DM. Saline infusion sonography and endometrial sampling compared with endometrial biopsy in diagnosing endometrial pathology. Obstet Gynecol. 2009;113(4):881–7.

    Article  PubMed  Google Scholar 

  20. Abou-Salem N, Elmazny A, El-Sherbiny W. Value of 3-D sonohysterography for detection of intrauterine lesions in women with abnormal uterine bleeding. J Minim Invasive Gynecol. 2010;17(2):200–4.

    Article  PubMed  Google Scholar 

  21. Van Dongen H, de Kroon CD, Jacobi CE, Trimbos JB, Jansen FW. Diagnostic hysteroscopy in abnormal uterine bleeding: a systematic review and meta-analysis. BJOG. 2007;114(6):664–75.

    Article  PubMed  Google Scholar 

  22. Lasmar RB, Barrozo PR, de Oliveira MA, Coutinho ES, Dias R. Validation of hysteroscopic view in cases of endometrial hyperplasia and cancer in patients with abnormal uterine bleeding. J Minim Invasive Gynecol. 2006;13(5):409–12.

    Article  PubMed  Google Scholar 

  23. Sismondi P, Biglia N, Volpi E, Giai M, de Grandis T. Tamoxifen and endometrial cancer. Ann N Y Acad Sci. 1994;734:310–21.

    Article  CAS  PubMed  Google Scholar 

  24. Fisher B, Costantino JP, Wickerham DL, Cecchini RS, Cronin WM, Robidoux A. Tamoxifen for prevention of breast cancer: report of the National Surgical Adjuvant Breast and Bowel Project P1 Study. J Natl Cancer Inst. 2005;97(22):1652–62.

    Article  CAS  PubMed  Google Scholar 

  25. ACOG Committee opinion on tamoxifen and uterine cancer. Number 336, June 2006.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Shalini Rajaram MD, FAMS .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer India

About this chapter

Cite this chapter

Rajaram, S., Yadav, G. (2015). Clinical Evaluation of Abnormal Uterine Bleeding. In: Rajaram, S., K, C., Maheshwari, A. (eds) Uterine Cancer. Springer, New Delhi. https://doi.org/10.1007/978-81-322-1892-0_5

Download citation

  • DOI: https://doi.org/10.1007/978-81-322-1892-0_5

  • Publisher Name: Springer, New Delhi

  • Print ISBN: 978-81-322-1891-3

  • Online ISBN: 978-81-322-1892-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics