Abnormal Bleeding

To assess the reason behind abnormal uterine bleeding a clinician will obtain a thorough history and review the duration and amount of bleeding, any factors that seem to bring the bleeding on, any symptoms accompanying the bleeding such as pain, fever, or vaginal odor, if bleeding occurs during intercourse, a personal or family history of bleeding disorders, medications that might cause bleeding, recent weight changes, new exercise program, or any other underlying medical problems. After a history is obtained, a physical examination is performed to evaluate overall health and pelvic examination to confirm bleeding is from uterus and not another site. The pelvic examination will include an external genitalia assessment; a speculum examination will also be conducted. In speculum examination, the clinician will look for obvious lesions and examine the cervix to look for signs of cervical bleeding and might also obtain a pap smear and/or HPV test to screen for cervical cancer. A bimanual examination will then be performed to assess the size and shape of the uterus and will assess the ovaries as well. After a physical examination, lab tests will be performed; a pregnancy test, cervical culture if there is abnormal vaginal discharge, blood tests for clotting, thyroid function, liver disease, and/or kidney problems will be performed.

If there is still uncertainty in diagnosis, endometrial assessment will be done which would include an endometrial biopsy, transvaginal ultrasound, sonohysterography, hysteroscopy, dilation and curettage for prolonged or excessive bleeding due to hormonal changes and is unresponsive to other treatments.

Abnormal uterine bleeding is classified into a system referred to the acronym of PALM-COEIN by the International Federation of Gynecology and Obstetrics in 2011. Abnormal uterine bleeding is first classified into heavy menstrual bleeding (AUB/HMB) or untermenstrual bleeding (AUB/IMB) and then divided into the acronym classification system between structural and non-structural causes. Structural causes consist of Polyp (AUB-P); Adenomyosis (AUB-A); Leiomyoma (AUB-L) Malignancy and hyperplasia (AUB-M). Non-structural causes include Coagulopathy (AUB-C); Ovulatory dysfunction (AUB-O); Endometrial (AUB-E); Iatrogenic (AUB-I); and not yet classified (AUB-N).

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