This document discusses abnormal uterine bleeding, which is vaginal bleeding that is irregular, excessive, or occurs between periods. It defines various types of abnormal bleeding and their causes, which can include fibroids, polyps, hormonal issues, or cancer. The PALM-COEIN system classifies the underlying causes. Diagnosis involves tests like ultrasounds, biopsies, and blood tests. Treatment depends on the underlying cause but may include medications, surgery, or hormone therapy.

1. ABNORMAL UTERINE BLEEDING
MENSTRUAL BLEEDING DISORDERS
Dr. Moses Owiti

2. Abnormal Uterine Bleeding is vaginal bleeding from
the uterus that is abnormally frequent, last
excessively long, is more than normal, or is irregular.
Normal:
Frequency - 28 +/- 7 days
Duration - 5 - 7 days
Amount - 20 - 80 mls.

3. Objectives
• I. Understanding the symptoms and aetiology of abnormal
uterine bleeding (AUB).
• Define terminology used in AUB
• Understand the symptoms, investigation and management
of AUB
• Understand the causes and investigation of dysmenorrhea
• Understand the action of medication used for menorrhagia
and dysmenorrhea.

4. Terminology
• Amenorrhea
Amenorrhea is the absence of menstrual bleeding.
• Primary amenorrhea is the failure of menses to occur by age 16
years, in the presence of normal growth and secondary sexual
characteristics.
• Secondary amenorrhea is defined as the cessation of menses
sometime after menarche has occurred.

5. •Menorrhagia/hypermenorrhea
menstruation at regular cycle intervals but with excessive flow and
duration
• Metrorrhagia/intermenstrual bleeding
uterine bleeding at irregular intervals, particularly between the
expected menstrual periods
• Menometrorrhagia
is a condition in which prolonged or excessive uterine bleeding
occurs irregularly and more frequently than normal. It is thus a
combination of metrorrhagia and menorrhagia.
• Polymenorrhea
menstrual cycle that is shorter than 21 days.
• Oligomenorrhoea
Regular menses that are more than 35 days apart.
• Post-coital Bleeding. Bleeding after sexual intercourse
• Premenarchal bleeding. Bleeding before menachre.
• Post-menopausal bleeding. Bleeding more than 1 year after
cessation of periods

6. Classification
The PALM COEIN
classification system is
commonly used.
P - polyps
A- adenomyosis
L - Leiomyoma
M - Malignancy
C - coagulopathy
O - ovulatory disorders
E - endometrial
I - Iatrogenic
N - Not classified (others)

7. Causes
• Premenarchral
1. Foreign body
2. Endogenous estrogen
3. Adrenal/ Pituitary tumors
4. Vaginal/ cervical cancer

8. • Post menopausal
• Benign causes
• Atrophy (Endometrial, cervical, vaginal)
• Malignant causes
• Ovarian, vaginal, cervical, vulval cancer
• Exogenous causes
• Hormone replacement therapy
• Anticoagulants.

9. • Reproductive age
• Pregnancy
• Ectopic pregnancy
• Early abortion
• Molar pregnancy
• Abnormal growth
• Leiomyoma
• Endometrial/ endocervical polyp
• Intrauterine contraceptive device
• Infection
• Endometritis
• Bacterial vaginosis
• PID
• Systemic
• Thyroid problem
• Coagulopathy
• Liver failure
• Renal failure
• DUB
• Anovulatory
• Ovulatory (Prostaglandin
production increased)

10. Diagnosis
• Beta HCG
• CBC
• Pap - smear (rule out HPV)
• Hysteroscopy
• Transvaginal or abdomino-pelvic ultrasound
• Endometrial Biopsy

11. Management
• NSAIDS - block prostaglandin effect
• Oral contraceptive - DUB
• Antifibrinolytics - reduce bleeding - Tranexamic Acid
• Iron supplements
• Surgery
• D&C
• Hysterectomy