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