1. AUB
Definitions
Significance.
Classifications

2. Definition Any deviation in normal Normal?? frequency, 28 ± 7 duration
amount of menstruation
Normal??
28 ± 7
1-8 (3-5)
10-80ml (30-50)
Can also include vaginal bleeding before menarche and after menopause

3. Definitions contd
Menorrhagia: Excessive (>80 ml) & / or prolonged menstruation(>7), at regular intervals
Metrorrhagia - Irregular, frequent bleeding of varying amounts but not excessive
Menometrorrhagia Prolonged or excessive bleeding at irregular intervals
Polymenorrhea Regular bleeding at intervals of less than 21 days
Oligomenorrhea Bleeding at intervals greater than 35 days – may be irregular
Intermenstrual Uterine bleeding between regular cycles

4. Others…
Hypermenorrhea – similar to menorrhagia but usually refers to heavy mensus (in terms of amount)
Hypomenorrhea (cryptomenorrhea) – regular scanty bleeding
Could be due to anatomic or hormonal abnormalities
Anatomic – imperforated hymen, incomplete transverse vaginal septum, cervical or vaginal stenosis, asherman’s syndrome.
Hormonal – hypothyroidism, hyperprolactinemia, hyperinsulinemia

5. METROTAXIS: continuous uterine bleeding without interruption
Contact bleeding – post coital or post examination bleeding. 2/3 – unknown causes
Cervicitis or vaginitis – e.g. – Chlamydia, trichomonas
Cervical ca
Cervical polyps
Cervical eversion
Atrophic vaginitis
METROTAXIS: continuous uterine bleeding without interruption
Amenorrhea – no mensus for 6 months
cervical cancer unless R/O

6. Novak’s gynaecology 14th edition

7. Why do we have to know about AUB??
Abnormal uterine bleeding affects 10 to 30 percent of reproductive-aged women and up to 50 percent of perimenopausal women
It is a common reason for gynecologic consultation.
Responsible for over one third of hysterectomies.

8. Classification of AUB Childhood Adolescence
Mostly vaginal – vulvovaginitis, trauma, neoplasms, precosious puberty
Adolescence
DUB – anovulation mostly…., sexual abuse, STDs
Child bearing age – r/o pregnancy
Pregnancy related, STDs, myomas. Etc.
Peri menopausal
DUB
Post menopausal - r/o malignancies
Tumors, atrophy

9. Classification of causes

10. Classifications contd.
AUB
Non- Obstetric
Non- gynaecologic
Systemic
Local
Gynaecologic
Obstetric
Classifications contd.
Endocrinopathies
Coagulopathies
Hepatic and renal failure
DUB
Lieomyoma
Adenomyosis
Polyps
Tumors
Infections
Trauma
Urethral bleeding
Rectal bleeding
Abortion
Ectopic pregnancy
GTD
Implantation bleeding

11. Gynecologic causes - uterus
Uterine fibroids
Adenomyosis – also called ‘endometriosis interna’, refers to ectopic endometrial tissue within the myometrium
possibly results from increased and abnormal vascularization of the endometrial lining
Is also associated with dysmenorrhea

12. Gyn. Contd.
Endometrial polyps – are also associated with AUB possibly due to asynchronous shedding to that of the normal endometrium
Thus usually associated with intermenustrial bleeding.
Endometrial hyperplasia and cancer –
Endometrial cancer should be suspected in any woman in menopausal transition with abnormal uterine bleeding
Two thirds of women with endometrial cancer present with postmenopausal bleeding
Only about 5% of endometrial ca occurs in patients younger than 40 yrs

13. Gyn. Contd. Other uterine lesions include: Atrophic endometrium
Infections – STD, TB
Mechanical causes – e.g. - IUD
Arteriovenous malformation

14. Non uterine gyn, causes Ovary - ???
Fallopian tube – salphingitis, Cancer
Cervix – Cancer, polyps, Infections
Vagina – Cancer, infections, atrophic vaginitis, foreinbody, Trauma

15. Systemic causes…
Endocrinopathies – Hypo or hyperthyroidism, hyperprolactinemia, adrenal disorders, DM
Coagulopathies
Factor deficiency – von willebrand’s disease, hemophilia
Palate disorders – ITP, leukemia, aplastic anemia etc.
Hepatic and renal failure – deficiency due to decreased synthesis and increased loss respectively

16. What is the most common cause of AUB???
DUB
(50%)

17. References Williams Gynecology
Berek & Novak's Gynecology, 14th Edition
Danforth's Obstetrics and Gynecology, 9th Ed
Wikipedia