Abnormal Uterine Bleeding

Question 1

What are the main causes of abnormal uterine bleeding?

Answer 1

Remember the mnemonic PALM COEIN:

PALM represents visually objective structural criteria: Polyps, Adenomyosis, Leiomyoma, Malignancy

COEIN for causes unrelated to structural anomalies: Coagulopathy, Ovulatory disorders, Endometrial, Iatrogenic, and Not classified causes

Question 2

What are the different types of abnormal uterine bleeding?

Answer 2

Heavy menstrual bleeding (HMB), intermenstrual bleeding (IMB), postcoital bleeding (PCB) and postmenopausal ­ bleeding (PMB)

Question 3

What are the general initial investigations undertaken for abnormal uterine bleeding?

(HMB, IMB, PCB, and PMB)

Answer 3

• Speculum examination of the cervix, with swabs for microbiology and cervical smear if indicated.
• Transvaginal ultrasound scan (TVUSS) and endometrial biopsy (EB) as necessary.
• OP hysteroscopy and further biopsies may be indicated.