Management of abnormal uterine bleeding in reproductive. A common and often debilitating condition, affecting women of reproductive age. Abnormal uterine bleeding aub may be acute or chronic and is defined as bleeding from the uterine corpus that is abnormal in regularity, volume, frequency, or duration and occurs in the absence of pregnancy 1 2. It also includes bleeding that happens before puberty or after menopause. Abnormall uterine bleeding is the most common cause of abnormal vaginal bleeding during a womans reproductive years. Et iol gy of abnormal ute ri ne bl ee din g aetiology of abnormal uterine bleeding general causes local causes dysfunctional 1. Primary care management of abnormal uterine bleeding aub. Most conditions that cause abnormal uterine bleeding can occur at any age, but some are more likely to occur at a particular time in a womans life. This chapter examines the modes of presentation and the causes of such symptoms, which range from physiological variations to more sinister underlying pathology. Abnormal uterine bleeding is defined as any alteration in the volume, pattern or duration of menstrual blood flow. Menstruation, or period, is a womans monthly bleeding. Sexual abuse is a prime consideration in recurrent vaginal bleeding. It is responsible for about half of the women with abnormal uterine bleeding in reproductive age ewenstein, 1996. Introduction there can be no other disease or condition that affects so many people on such a regular basis with consequences, at both the individual and societal levels, which is not prioritised in some way by health professionals or policy makers.
Abnormal uterine bleeding british medical bulletin. Figo classification system palmcoein for causes of abnormal uterine bleeding in nongravid women of reproductive age. Abnormal uterine bleeding is an extremely common indication for referral to a gynaecologist. Dysfunctional uterine bleeding is more common in the extremes of the reproductive era, while the incidence of cancer as a cause of bleeding is greatest in the perimenopausal and. What is the pathophysiology of abnormal uterine bleeding aub. Abnormal uterine bleeding dysfunctional uterine bleeding ncbi. Abnormal uterine bleeding aub is a condition that affects approximately 30% of women during their reproductive years. Abnormal uterine bleeding murtaghs general practice, 7e. Abnormal uterine bleeding is one of the most common reasons for women to seek for care. During the first 14 days follicular phase of the menstrual cycle, the.
Abnormal uterine bleeding is a frequent condition in gynecology. Problem bleeding is among the most common gynecologic complaints of reproductive age women in ambulatory care settingsof similar frequency to the number seeking care for urinary tract infections and vaginitis. Abnormal uterine bleeding aub is bleeding from the uterus that is longer than usual or that occurs at an irregular time. It is a diagnosis of exclusion made after structural causes of bleeding and chronic medical diseases have been ruled out. Vaginal bleeding may also occur during early pregnancy or during late pregnancy. The pathophysiology is not fully understood and it is complex. Dysfunctional uterine bleeding is a diagnosis of exclusion. Anovulatory or dysfunctional uterine bleeding dub dysfunctional uterine bleeding is the occurrence of uterine bleeding unrelated to structural abnormalities of the uterus or the endometrial lining. The diagnosis and treatment of dysfunctional uterine bleeding can be a long emotional journey for the patient and a difficult challenge for the provider. The management of dysfunctional uterine bleeding glowm.
If you have any bleeding when you are pregnant, be sure to call. Dysfunctional uterine bleeding describes the spectrum of abnormal bleeding patterns in the abscence of a medical illness or pelvic pathology. Abnormal uterine bleeding bleeding not caused by pelvic pathology, medications, systemic disease or pregnancy menorrhagia. Abnormal uterine bleeding is a common presenting problem in the emergency department ed. Abnormal uterine bleeding a free powerpoint ppt presentation displayed as a flash slide show on id. The uterine and ovarian arteries supply blood to the uterus. Your monthly periods may last longer or shorter, and bleeding may be heavier or lighter than usual. Dysfunctional uterine bleeding describes the sp ectrum of abnormal bleeding patterns in the abscence of a medical illness or pelvic pathology. The normal menstrual cycle is 28 days and starts on the first day of menses. Dysfunctional uterine bleeding dub represents a particular type of abnormal uterine bleeding aub, and is defined in the usa as an excessive, prolonged and irregular bleeding of the endometrium. Over the history of medicine, there has been a wide range of poorly defined terminology used to describe aub symptoms and etiologies. Unit of gynecology and obstetrics, department of human pathology in. Bleeding may be heavier or lighter than usual and occur often or randomly. Pathophysiology of abnormal uterine bleeding sciencedirect.
In the general population, abnormal uterine bleeding is estimated to affect 11 to percent of reproductive age women at any given time. Recommendations for patient evaluation are given, and the value of the various diagnostic measures is discussed. The pathophysiology of dub is largely unknown but occurs in both ovulatory and anovulatory menstrual cycles. Abnormal uterine bleeding aub is a frequent cause of visits to health care provider during adolescent period and is characterized by irregular, excessively heavy, prolonged andor frequent bleeding of uterine origin. Aub frequently coexists with fibroids, but the relationship between the two remains incompletely understood and in many women the identification of fibroids may be incidental to a menstrual bleeding. Dysfunctional uterine bleeding dub, the most common cause of abnormal uterine bleeding, occurs most often in women 45 50% of cases and in adolescents 20% of cases. M enstrual bleeding is considered normal when it occurs regularly every 25 days, lasts 4 to 8 days, and is not associated with heavy bleeding. Dysfunctional uterine bleeding must be distinguished from the other causes of abnormal genital bleeding listed in box 156. Relation between menstrual blood loss and patients subjective assessment of loss, duration of bleeding. Dysfunctional uterine bleeding occurs when the cycles hormonal signals get thrown off. The relationship between age and various causes of abnormal uterine bleeding. Perimenopausal women distressing from abnormal uterine.
Dysfunctional uterine bleeding is a common problem in women in the 3050 years age group. This article provides nps with a practical overview of the process from chief complaint to followup care. Abnormal uterine bleeding due to ovulatory dysfunction aubo is abnormal uterine bleeding that, after examination and ultrasonography, cannot be attributed to the usual causes structural gynecologic abnormalities, cancer, inflammation, systemic disorders, pregnancy, complications of pregnancy, use of oral contraceptives or certain drugs. The figo systems for nomenclature and classification of causes of abnormal uterine bleeding in the reproductive years. Vaginal bleeding can originate anywhere in the genital tract, including the vulva, vagina, cervix, and uterus. Dysfunctional uterine bleeding dub is abnormal bleeding from the vaginal area that is due to modifications in hormonal agent levels. You may have bleeding from your uterus at times other than your normal monthly period.
Acute aub refers to an episode of heavy bleeding that, in the opinion of the clinician, is of sufficient quantity to require immediate intervention to prevent further blood loss 1. Abnormal uterine bleeding previously, dysfunctional uterine bleeding dub is irregular uterine bleeding that happens in the absence of recognizable pelvic pathology, basic medical disease, or pregnancy. The pathophysiology of abnormal uterine bleeding depends on the patients age. It is a difficult condition for the woman, mentally as well as socially and also financially. Clinical practice clinical update dysfunctional uterine. Ppt abnormal uterine bleeding powerpoint presentation. Abnormal vaginal bleeding is different from normal menstrual periods. The abnormal uterine bleeding in postmenopausal women, vaginal bleeding after 12 months or more of cessation of menses, andor irregular.
This article presents the possible causes of abnormal bleeding, using an agebased approach. The normal cycle is triggered by signals from hormones. Treatment options for dysfunctional uterine bleeding. Dysfunctional uterine bleeding dub is often caused by a hormonal imbalance. It could be bleeding that is between periods, is very heavy, or lasts much longer than usual. Abnormal uterine bleeding due to ovulatory dysfunction. It reflects a disruption in the normal cyclic pattern of ovulatory hormonal stimulation to the endometrial lining.
Uterine and systemic causes must be excluded before the diagnosis is made. Pathophysiology of the female reproductive system part i lois e brenneman, msn, anp, fnp, c dysfunctional uterine bleeding definitions. Pdf dysfunctional uterine bleeding dub represents a particular type of abnormal. Abnormal uterine bleeding etiology bmj best practice. Know the types, causes, symptoms, treatment and diagnosis of dysfunctional uterine bleeding. Its most common during puberty and menopause, but can occur at any time during a womans life. A systematic approach to chronic abnormal uterine bleeding. The options for nonsurgical management are also presented. Overview of abnormal uterine bleeding in adolescents. Abnormal dysfunctional uterine bleeding in emergency. Dysfunctional uterine bleeding is basically abnormal vaginal bleeding in the reproductive years of a woman. Although many etiologies cause aub, the one most likely cause among adolescents are dysfunctional uterine bleeding dub. Abnormal uterine bleeding aub is a common and debilitating condition with high direct and indirect costs. Abnormal uterine bleeding has various definitions and.
Abnormal uterine bleeding formerly, dysfunctional uterine bleeding dub is irregular uterine bleeding that occurs in the absence of recognizable pelvic pathology, general medical disease, or pregnancy. Abnormal uterine bleeding aub is the name currently used. Dysfunctional uterine bleeding what you need to know. Mechanisms of abnormal uterine bleeding oxford academic. One of the most common causes of abnormal uterine bleeding is pregnancy or pregnancyrelated problems such as ectopic pregnancy when a fertilized egg implants someplace other than the uterus or miscarriage. This will depend on the cause of the abnormal uterine bleeding if a chronic illness or a blood disorder is at the root of your symptoms, treating that can help. Management of abnormal uterine bleeding in reproductive period evidencebased good clinical practice recommendations for indian women a gynae endocrine society of india gesi initiative in collaboration with endocrine committee of association of obstetricians and gynaecologists of delhi chairpersons. Health care practitioners deal with this problem frequently. It may impact physical, emotional sexual and professional aspects of the lives of women, impairing their quality of life. Abnormal d ysfunctional uterine bleeding aub is defined as abnormal uterine bleeding in the absence of organic disease.
When vaginal bleeding originates in the uterus, it is called abnormal uterine bleeding aub. Dysfunctional uterine bleeding, also called anovulatory bleeding, is any bleeding from the vagina that varies from a womans normal menstrual cycle. It is estimated that 5% of women between the ages 30 and 49 will seek treatment each year for dysfunctional uterine bleeding dub. Figo classification system palmcoein for causes of. Abnormal uterine bleeding can be due to a number of organic and dysfunctional causes. Abnormal uterine bleeding aub is any variance of the normal menstrual cycle, which is defined on the basis of four parameters frequency, regularity, duration, and volume.
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