1. AUB
Definitions
Significance.
Classifications
Bethelhem Berhanu

2. Definition
• Any deviation in normal
frequency,
duration
amount of menstruation
Normal??
28 7
1-8 (3-5)
10-80ml
(30-50)
Can also include vaginal bleeding before
menarche and after menopause

3. Definitions contd
• Menorrhagia: Excessive (>80 ml) & / or prolonged
menstruation(>7), at regular intervals
• Metrorrhagia - Irregular, frequent bleeding of
varying amounts but not excessive
• Menometrorrhagia Prolonged or excessive
bleeding at irregular intervals
• Polymenorrhea Regular bleeding at intervals of
less than 21 days
• Oligomenorrhea Bleeding at intervals greater than
35 days – may be irregular
• Intermenstrual Uterine bleeding between regular
cycles

4. Others…
• Hypermenorrhea – similar to menorrhagia
but usually refers to heavy mensus (in terms
of amount)
• Hypomenorrhea (cryptomenorrhea) – regular
scanty bleeding
– Could be due to anatomic or hormonal
abnormalities
• Anatomic – imperforated hymen, incomplete
transverse vaginal septum, cervical or vaginal
stenosis, asherman’s syndrome.
• Hormonal –
hypothyroidism, hyperprolactinemia, hyperinsulinemia

5. • Contact bleeding – post coital or post examination
bleeding. 2/3 – unknown causes
Cervicitis or vaginitis – e.g. – Chlamydia, trichomonas
Cervical ca
cervical
Cervical polyps
cancer unless
Cervical eversion
R/O
Atrophic vaginitis
• METROTAXIS: continuous uterine bleeding without
interruption
• Amenorrhea – no mensus for 6 months

6. Novak’s gynaecology 14th edition

7. Why do we have to know about AUB??
• Abnormal uterine bleeding affects 10 to 30
percent of reproductive-aged women and up
to 50 percent of perimenopausal women
• It is a common reason for gynecologic
consultation.
• Responsible for over one third of
hysterectomies.

8. Classification of AUB
Childhood
• Mostly vaginal – vulvovaginitis, trauma, neoplasms, precosious
puberty
Adolescence
• DUB – anovulation mostly…., sexual abuse, STDs
Child bearing age – r/o pregnancy
• Pregnancy related, STDs, myomas. Etc.
Peri menopausal
• DUB
Post menopausal - r/o malignancies
• Tumors, atrophy

9. Classification of causes

10. Classifications contd.
Systemic
NonObstetric
Nongynaecologic
Endocrinopathies
Coagulopathies
Hepatic and renal
failure
DUB
Gynaecologic
AUB
Obstetric
Lieomyoma
Adenomyosis
Polyps
Tumors
Infections
Trauma
Abortion
Ectopic pregnancy
GTD
Implantation
bleeding
Local
Urethral bleeding
Rectal bleeding

11. Gynecologic causes - uterus
• Uterine fibroids – especially submucous type.
–
–
–
–
Higher surface area
Venous congestion
Dysregulation of local vasoactive growth factors
Interfere with myometrial contractility
• Adenomyosis – also called ‘endometriosis
interna’, refers to ectopic endometrial tissue
within the myometrium
– possibly results from increased and abnormal
vascularization of the endometrial lining
– Is also associated with dysmenorrhea

12. Gyn. Contd.
• Endometrial polyps – are also associated with
AUB possibly due to asynchronous shedding to
that of the normal endometrium
– Thus usually associated with intermenustrial bleeding.
• Endometrial hyperplasia and cancer –
Endometrial cancer should be suspected in any woman
in menopausal transition with abnormal uterine
bleeding
Two thirds of women with endometrial cancer present
with postmenopausal bleeding
Only about 5% of endometrial ca occurs in patients
younger than 40 yrs

13. Gyn. Contd.
• Other uterine lesions include:
– Atrophic endometrium
– Infections – STD, TB
– Mechanical causes – e.g. - IUD
– Arteriovenous malformation

14. Non uterine gyn, causes
•
•
•
•
Ovary - ???
Fallopian tube – salphingitis, Cancer
Cervix – Cancer, polyps, Infections
Vagina – Cancer, infections, atrophic
vaginitis, foreinbody, Trauma

15. Systemic causes…
• Endocrinopathies – Hypo or
hyperthyroidism, hyperprolactinemia, adrenal
disorders, DM
• Coagulopathies
– Factor deficiency – von willebrand’s
disease, hemophilia
– Palate disorders – ITP, leukemia, aplastic anemia
etc.
• Hepatic and renal failure – deficiency due to
decreased synthesis and increased loss respectively

16. What is the
most
common
cause of
AUB???
DUB
(50%)

17. References
•
•
•
•
•
•
•
Williams Gynecology
Berek & Novak's Gynecology, 14th Edition
Danforth's Obstetrics and Gynecology, 9th Ed
Wikipedia
www.figo.com
www.acog.com
www.slideshare.com