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Abnormal uterine bleeding
1Harvard Medical School, Division of General Internal Medicine E-CC63 IH, Boston, MA 02215, USA. sfazio@bidmc.harvard.edu
Southern Medical Journal
|April 27, 2007
Summary
Abnormal uterine bleeding is common. Evaluation involves determining ovulatory or anovulatory causes to guide treatment and prevent complications like endometrial hyperplasia, especially in postmenopausal women.
Area of Science:
- Gynecology
- Reproductive Endocrinology
Background:
- Menstrual cycle disorders are frequent in ambulatory care.
- Abnormal uterine bleeding (AUB) encompasses excessive or irregular uterine bleeding.
- Pregnancy must be ruled out in premenopausal women with AUB.
Purpose of the Study:
- To outline the diagnostic approach to abnormal uterine bleeding.
- To emphasize the importance of differentiating ovulatory from anovulatory bleeding.
- To discuss management strategies based on menstrual cycle patterns and menopausal status.
Main Methods:
- Clinical evaluation of patients presenting with abnormal uterine bleeding.
- Differential diagnosis considering common causes like anovulation.
- Assessment of menstrual patterns (oligomenorrhea, amenorrhea) and menopausal status (pre-, peri-, postmenopausal).
Main Results:
- Anovulation is a primary cause of AUB, necessitating management to minimize blood loss and prevent unopposed estrogen effects.
- Oligomenorrhea/amenorrhea requires estrogen maintenance for bone health.
- Increased risk of endometrial hyperplasia and malignancy in peri- and postmenopausal women warrants prompt endometrial assessment.
Conclusions:
- A systematic approach to AUB is crucial for effective management.
- Tailoring treatment to the underlying cause (ovulatory vs. anovulatory) and menopausal status is essential.
- Vigilance for endometrial pathology is paramount in older age groups.
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