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Abnormal Uterine Bleeding (AUB), Premenopausal, Non-Pregnant Patients


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Note: I copy the "definition" of something straight from the book. I find it's best to have an all-encompassing definition in order to better orient myself when I am studying.

(Definitions of Terms Related to AUB [Very Useful IMO] - Click to expand)

Mensrual Cycle Terms Descriptive Terms Definition
Frequency (interval between the start of each menstrual cycle) Infrequent > 38 days
Normal 24 to 30 days
Frequent < 24 days
Regularity (variation of menstrual cycle length, measured over 12 months) Regular ± 2 to 20 days over 12 months
Irregular > 20 days over 12 months
Duration of Menstruation Shortened < 4½ days
Normal 4½ to 8 days
Prolonged > 8 days
Volume (total blood loss each menstrual cycle) Light < 5 mL
Normal 5 to 80 mL
Heavy > 80 mL
Other Terms

Note: terms may differ from other definitions of amenorrhea.
Amenorrhea No bleeding for 90 days.
Primary Amenorrhea Absent menarche by 15 years.
Secondary Amenorrhea Amenorrhea for 6 months with previously regular menstrual cycles.
Menopause Amenorrhea for 12 months without other apparent cause.
Precocious Menstruation Menarche before 9 years of age.

From AAFP:Abnormal uterine bleeding is a symptom, not a diagnosis; the term is used to describe bleeding that falls outside population-based 5th to 95th percentiles for menstrual regularity, frequency, duration, and volume (see above table). Abnormal bleeding is considered chronic when it has occurred for most of the previous six months, or acute when an episode of heavy bleeding warrants immediate intervention. Intermenstrual bleeding is bleeding that occurs between otherwise normal menstrual periods. Use of imprecise terms such as menorrhagia, metrorrhagia, and dysfunctional uterine bleeding is now discouraged.

From CCFP:Abnormal uterine bleeding has various definitions and classifications. It can be loosely defined as a variation from the normal menstrual cycle. The variation can be in regularity, frequency, duration of flow, or amount of blood loss. Often the bleeding is “heavy,” which is “excessive menstrual blood loss which interferes with a woman’s physical, social, emotional and/or material quality of life.” The terms menorrhagia and metrorrhagia, as well as other combinations, have become outdated.


Likely not important, could not find clear source.

Predisposing factors

  1. Risk factors related to Endometrial cancer: (AUB is the most common sx in endometrial cancer) (Click to expand)
    1. Major: Long term use of unopposed estrogen/hereditary nonpolyposis colorectal cancer/estrogen-producing tumor.
    2. Minor: Nulliparity/PCOS/Infertility/Late menopause/Tamoxifen/(T2DM, HTN, Gallbladder disease, thyroid disease).
  2. Risk for polyps increases with age.

Common Findings

AUB may encompass changes in regularity, frequency, duration of flow, or amount of blood loss during menses.

Other Signs and Symptoms

Related to specific pathology.


Consider asking about patient expectations, as people will often have an idea of what they want via online, etc.

  1. HPI:
  2. ROS:
  3. ALL/MEDS/HIITS: (What are HIITS? - Click to expand)
  5. SOCHx:

Physical Exam

Coming soon

Diagnostic Tests

Initially assess for hemodynamic stability, anemia, identifying source of bleeding, pregnancy testing, ruling out endometrial carcinoma.

  1. CBC with diff. (check for thrombocytopenia)
  2. Depending on cause: hormone levels, PT/PTT, TFTs
  3. If age > 45 yrs, AUB, obtain endometrial sampling
  4. Pelvic ultrasound 1st line, then TVUS
  5. Always urine or serum pregnancy test


A universal system categorizing AUB into structural vs. non-structural causes has emerged, PALM (structural)-COEIN (non-structural).

  1. Polyp,
  2. Adenomyosis,
  3. Leiomyoma,
  4. Malignancy
  5. Coagulopathy
  6. Ovulatory dysfunction
  7. Endometrial
  8. Iatrogenic
  9. Non-classified


  1. General: Keep menstrual diary to identify periods of large flow.
  2. Rx therapy includes: hormonal, NSAIDs, anti-fibrinolytic.


Likely not important, however bleeding may increase initially with hormone therapy, so follow up after 1 month.


When a non-gynecologic cause is suspected.

Individual Considerations

Pregnancy discussed in another section.

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