Abnormal uterine bleeding

Blog Post  by Malcolm G. Munro MD, FACOG, FRCS(c), Professor, Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Director of Gynecologic Services, Kaiser Permanante, Los Angeles Medical Center, Los Angeles, CA, USA

Many medical students, registrars/residents, primary care physicians and even gynecologic specialists struggle when confronted with a patient with abnormal uterine bleeding (AUB) in the reproductive years. This is no surprise as both the investigation and management of abnormal AUB in such women has been hampered by confusing and inconsistently applied nomenclature and the lack of standardized methods for investigation and categorization of the various potential causes of the problem.(1, 2) Terms such as “menorrhagia” and “dysfunctional uterine bleeding” frequently have different meanings in different environments, often resulting in misinterpretation of patients, colleagues, and textbooks or the medical literature. In addition, while many potential causes of AUB are invisible such as endometrial defects or coagulopathies, many uterine entities that are discernable, such as adenomyoais, leiomyomas, and endometrial polyps, are frequently asymptomatic.