2. PLAN
1. Definition
2. Clinical types of abnormal uterine bleeding
1. Menorrhagia
2. Hypomenorrhoea
3. Metrorrhagia
4. Polymenorrhoea
5. Menometrorrhagia
6. Oligomenorrhoea
7. Contact bleeding
8. Amenorrhoea
9. Dysmenorrhoea
3. Evaluation of abnormal bleeding
1. Clinical history
2. Physical exam
3. Investigations
4. General principles of management
3. 1- Definition
• Any bleeding from uterus that differs materially from
that of the normal menstrual cycle in frequency of
occurrence, in amount or in duration of flow.
• It applies to both menstrual and non menstrual
disturbances due to
– Organic disease either benign or malignant
– Or to systemic or psychogenic origin
• Between menarche and menopause, almost every
woman experiences one or more episodes of
abnormal uterine bleeding.
4. 2- Clinical types of abnormal uterine bleeding
Menorrhagia (hypermenorrhoea)
Cyclical menstrual bleeding excessive in amount and/ or
prolonged in duration
Causes:
Uterine fibroids
Complication of undiagnosed pregnancy
Adenomyosis
Endometrial hyperplasia
Malignant tumours
Endometritis
Dysfunctional bleeding
5. 2- Clinical types of abnormal uterine bleeding
Hypomenorrhoea (cryptomenorrhoea)
An abnormally small amount of menstrual flow usually
spotting
Causes:
Cervical stenosis
Congenital transverse vaginal membrane
Asherman syndrome
Endometrial tuberculosis
Polymenorrhoea
Periods occurring too frequently, usually less than 21 days
apart. Bleeding may or may not be abnormal in amount
Causes: anovulation (endocrine disorders)
6. 2- Clinical types of abnormal uterine bleeding
Metrorrhagia (intermenstrual bleeding)
Bleeding occuring at any time between menstrual
periods ranging from slight spotting to haemorragic
flow and from a single short episode to bleeding that
continues for days
Causes:
Endometrial polyps
Endometrial and cervical cancers
Exogenous oestrogen administration
7. 2- Clinical types of abnormal uterine bleeding
Menometrorrhagia
Uterine bleeding totally irregular in frequency and
duration of episodes and excessive in amount.
Causes:
Complications of pregnancy (abortion, hydatoform mole,
choriocarcinoma)
Malignant genital tract tumours
Oligomenorrhoea
Menstrual periods that occur more than 35 days apart.
Bleeding usually decreased in amount and duration
Causes: Menopause, Anovulation, Pregnancy
complications, Oestrogen-producing tumors
8. 2- Clinical types of abnormal uterine bleeding
Contact bleeding
Self-explanatory
Causes:
Cervicitis
Cervical cancer
Cervical eversion (ectropion)
Cervical polyps
Amenorrhoea
Failure to menstruate which is:
Physiology (before puberty, during pregnancy, puerperum and after
menopause)
Pathological
Primary amenorrhoea: congenital malformations, genetic disorders.
Secondary amenorrhoea
9. 2- Clinical types of abnormal uterine bleeding
Dysmenorrhoea
Painful menstruation, the commonest gynaecological
complaint, and leading cause of absenteism
primary dysmenorrhoea: idiopathic causes (theories)
secondary dysmenorrhoea: organic disease (PID,
endometriosis, fibroids, ...)
10. 3- Evaluation of abnormal uterine bleeding
Clinical history
Many causes of bleeding will be strongly suggested by
history alone.
Note amount of flow, duration of cycle, duration of
periods, number of episodes, LMP, menopause and any
change in general health
Physical examination
General health condition
Glands
Abdominal masses
Size of the uterus/ovaries
Cervix
11. Evaluation of abnormal uterine bleeding
Investigations
Pap smear
Endometrial Biopsy
Hysteroscopy
D & C
Hormonal assays
Ultrasound
Laparoscopy
12. 4- General principles of management
A careful clinical history, physical and pelvic
examination are vital.
Improved diagnostic technics and treatment have
resulted in better care of patients with abnormal
uterine bleeding.
13. References
Integrated Obstetrics and Gynaecology for
postgraduates by C.J. Dewhurst, 2nd
edition by
Blackwell Scientific Publications.
Obstetrics and Gynaecology (Scientific Foundations
of) by Elliot E Philipp, Josephine Barns and Michael
Newton International Edition (3rd edition)
Principles of Gynaecology, by Sir Norman Jeffwate,
Butterworths, 4th edition.