Abnormal Uterine Bleeding (AUB) Flashcards
What is AUB
Deviation from usual menstrual bleeding with respect to quantity of blood, flow, duration, regularity.
Most common form of AUB
HMB/menorrhagia
What are the main causes of AUB
PALM-COEIN
Polyps
Adenomyosis
Leiomyoma (fibroids)
Malignancy/hyperplasia
Coagulopathy
Ovulatory dysfunction
Endometrial causes
Iatrogenic
Not yet specified
What is menorrhagia
Heavy menstrual bleeding that causes significant impact on a woman’s quality of life, usually more than 80ml
What is the epidemiology of menorrhagia
Affects around 30% of women, around half of cases have no known cause
How can we divide the causes of menorrhagia
Local and systemic
What is menorrhagia without a known cause called?
Dysfunctional uterine bleeding
What are the local causes of menorrhagia
FAPPEE
- Fibroids
- Adenomyosis
- PID
- Polyps
- Endometrosis
- Endometrial cancer (esp if post menopausal)
What are the systemic causes of menorrhagia
HOLB
- Hypothyroidism
- Obesity
- Liver and kidney disease
- Bleeding disorder
What is a complication of menorrhagia
Anemia - fatigue, weakness, SOB and palpitations
What investigations should be done in menorrhagia
Bedside:
- Speculum and bimanual: exclude ectropion, feel for fibroids/masses
Bloods:
- FBC: rule out anemia
- LFT + coagulation profile
- TFT
Imaging:
- TVUSS: rule out fibroids/polyps
What is the main management for menorrhagia
Rule out underlying local or systemic pathology, if present then treat underlying cause
What is the management for dysfunctional uterine bleeding
Depends on whether mother wants to conceive:
Doesn’t want kids: Mirena coil/progesterone IUS
Wants kids: Mefenamic acid/TXA
2nd line: COCP
Surgical: endometrial ablation or hysterectomy (only use as last resort)
