This document discusses different types of abnormal uterine bleeding, including menorrhagia (excessive bleeding), polymenorrhhea/epimenorrhhea (frequent cycles with excessive bleeding), metrorrhagia (irregular bleeding), and oligomenorrhea and hypomenorrhea (scanty or infrequent bleeding). The causes of each type are organic issues like fibroids or adenomyosis, systemic illnesses, endocrine disorders, and dysfunctional uterine bleeding. A diagnosis is made based on symptoms and a physical exam, and treatment depends on the underlying cause.

1. Abnormal uterine bleeding
MENORRHAGIA
Definition
menorrhagia is defined as cyclic bleeding at normal intervals the
bleeding is either excessive in amount or duration or both
The term menotaxis is often used to denote prolonged bleeding.
Causes
Menorrhagia is a symptom of some underlying pathology -organic or
functional
Organic
Pelvic:- due to congestion increase surface area or hyperplasia of the
endometrium.
 Fibroid uterus
 Adenomyosis
 Pelvic endometriosis
 IUCD in utero
 Chronic tubo ovarian mass
 Tubercular endometritis
 Retroverted uterus due to congestion
 Granulosa cell tumor of the ovary
Systemic:-
 Liver dysfunction
 Congestive cardiac failure
 Severe hypertension
Endocrinal:-

2.  Hypothyroidism
 Hyperthyroidism
Blood dyscrasias
 Idiopathic thrombocytopenic purpura
 Leukemia
 Von Willbrand 's disease
Emotional upset
Functional
Due to Disturbed hypothalmao-pituitary ovarian endometrial axis
I. Dysfunctional uterine bleeding
II. Fibroid uterus
III. Adenomyosis
IV. Chronic tubo ovarian mass
Diagnosis
HC- long duration of flow , passage of big clots, use of increased
number of thick sanitary pad, pallorand low level of hemoglobingive
an idea about the correct diagnosis and magnitude of menorrhagia.
Treatment
The definitive treatment is appropriate to the cause for
menomerrhagia.
POLYMENORRHOEA/EPIMENORRHEA
Definition
Polymenorrhea is defined as cycle bleeding where the cycle is
reduced to an arbitrary limit of lesson 21 days and remains constant
at that frequency.

3. If the frequent cycle is associated with excessive and or prolonged
bleeding it is called epimenorrhea
Causes
 Dysfunctional
 Ovarian hyperaemia.
METRORRHAGIA
Definition
Metrorrhagia is defined as irregular acyclic bleeding from the uterus.
Amount of bleeding is variable
Clinical practice the bleeding from any part of the genital tract is
included.
Menometrorrhagia is the term applied when the bleeding is so irregular
and excessive that the mense cannot identified at all.
Causes of a cyclic bleeding
 DUB
 Submucous fibroid
 Uterine polyp
 Carcinoma cervix and endometrial carcinoma
 Vascular ectopy of the cervix especially during pregnancy , pill use
cervix.
 Infection Chlamydia or tubercular cervicitis.
 Cervical endometriosis
Causes of intermenstrual bleeding
 Urethral caruncle
 Ovular bleeding
 Breakthrough bleeding in pill use

4.  IUCD in utero
 Decubitus ulcer
OLIGOMENORRHEA
Definition
Menstrual bleeding occurring more then 35 days apart and which
remains constant
Constant at that frequency is called oligomenorrhea.
Causes
I. Age-related during adolescence and preceding menopause.
II. Weight related obesity
III. Stress and exercise related
IV. Endocrine disorders PCOS, hyperprolactinaemia,
hyperthyroidism
V. Androgen producing tumor ovarian ,adrenal
VI. Tuberculosis endometritis
HYPOMENORRHEA
Definition
When the menstrual bleeding is unduly scanty and last for less than 2
days. It is called hypomenorrhea
Causes
Uterine synechiae
Endometrial tuberculosis
Use of oral contraceptive
Thyroid dysfunction
Malnutrition