AUB is common in women. This ppt will clear all doubts

1. ABNORMAL
UTERINE
BLEEDING
Dr CH. SUNITA
ASSISTANT PROFESSOR
DEPARTMENT OF OBG

2. At the end of class you should know?
• DEFINITION
• CLASSIFICATION AND ETIOLOGY OF AUB
• CLINICAL FEATURES

3. NORMAL PHYSIOLOGY OF
MENSTRUATION

4. Physiological mechanisms of hemostasis in
normal menstrual cycles
• Platelet adhesion and plug formation with fibrin
• Local vasoconstriction
• Endometrium regeneration
• Biochemical: Increase in PGF2alpha, thromboxane and endothelin

5. DEFINITION
• Any uterine bleeding outside the normal volume, duration, regularity
or frequency is considered abnormal uterine bleeding
Normal menstruation
• Cycle interval : 28days (21-35 days)
• Menstrual flow : 4-5 days
• Menstrual blood loss : 35ml (20-80ml)

6. Patterns of abnormal uterine bleeding
Old terminology
• Menorrhagia
• Polymenorrhoea
• Metrorrhagia
• Oligomenorrhoea
• Hypomenorrhoea
• Dysfunctional uterine bleeding

7. Old terminology
Menorrhagia: Excessive & / prolonged menstruation at regular intervals
Polymenorrhoea : Frequent <21 days cycle at regular intervals
Metrorrhagia : Bleeding at irregular , frequent intervals, mount variable
Menometrorrhagia : Excessive & / or prolonged bleeding at irregular
intervals
Hypomenorrhoea: Scanty menstruation
Oligomenorrhoea: Infrequent menstruation >35 days
DUB (Dysfunctional uterine bleeding): AUB in the absence of pelvic
organ disease or systemic disorder.

10. New terminology
• HMB : Excessive menstrual blood loss which interferes with the
woman’s physical, emotional, social quality of life and which can occur
alone or in combination with other symptoms.
• Acute AUB: An episode of bleeding in a woman of reproductive age,
who is not pregnant, that is of sufficient quantity to require immediate
intervention to prevent further blood loss.
• Chronic AUB: Bleeding that is abnormal in duration, volume, and / or
frequency and been present for most of the last 6months.

11. ETIOLOGY

12. ETIOLOGY
• STRUCTURAL OR NON STRUCTURAL: PALM-COEIN
• LIFE CYCLE: PRE PUBERTAL
MENARCHAL
REPRODUCTIVE
POST- MENOPAUSE
• ANATOMIC: “BOTTOMS UP”

31. NOTATION OF AUB
• A patient may be found to have more than one cause for AUB.
Notation approach for this has been designed and categorized.
• For example, a patient found to have endometrial hyperplasia and
polyps, she is categorized as
• AUB P1 A0 L0 M1- C0 O0 E0 I0 N0

33. ETIOLOGY- ANATOMIC
“BOTTOMS UP”
• VULVA
• VAGINA
• CERVIX
• UTERUS
• OVARIES
CONTAGIUOS ANATOMY: GU, GI
NON PELVIS: ENDOGENOUS, IATROGENIC

34. VULVAR
• Infections
• HPV
• Atrophy
• Benign lesions
• Cancerous lesions
• Dermatological causes

35. VAGINA
• Malignancy: carcinoma, sarcoma
• Infections
• Foreign bodies: diaphragm, pessaries
• Laceration/ trauma
• Atrophic changes
• Granulomatous changes after surgeries

36. CERVIX
• Neoplasia: cancer, polyps, myomas
• Cervical eversion ( ectropion)
• Infections: cervicitis, condyloma acuminata

37. UTERUS
• Myomas/ fibroids
• Polyps
• Endometrial hyperplasia
• Endometrial carcinoma
• atrophy

38. OVARY
• Anovulation
• PCOS
• Menopause transition

40. 1. What does PALM- COEIN stand for ?

41. 2. If a young girl with her first menstrual period
presents with heavy menstrual bleeding and requires
transfusion, what should you test for

42. •r/o von Willebrand’s

43. 3. Coagulation disorders which can cause HMB

44. • Von willebrand
• Acquired ITP
• Leukemia
• Drug induced(coumadin/heparin/aspirin)

45. 4. Women with PCOS experience ovulatory/
anovulatory bleeding?

46. 5. AUB caused by medications or devices that act
on the endometrium comes under which category
of PALM- COEIN

47. 6