Evaluation and management of abnormal uterine bleeding

Area of Science:

• Gynecology
• Reproductive Health

Background:

• Abnormal uterine bleeding (AUB) is a frequent gynecological complaint in reproductive-aged women.
• Anovulation is a common cause, but bleeding can stem from various pathologies within or outside the reproductive tract.

Purpose of the Study:

• To define abnormal uterine bleeding (AUB) and its classification.
• To highlight the importance of focused history and pelvic examination in diagnosing AUB.
• To introduce the PALM-COEIN classification system for precise etiological definition.

Main Methods:

• Focused menstrual history elicitation.
• Appropriate patient evaluation, including pelvic examination.
• Application of the PALM-COEIN classification system for etiological categorization.

Main Results:

• AUB encompasses heavy menstrual bleeding (HMB), intermenstrual bleeding (IMB), and prolonged menstrual bleeding.
• The PALM-COEIN system categorizes AUB causes into Polyp, Adenomyosis, Leiomyoma, Malignancy and hyperplasia, Coagulopathy, Ovulatory dysfunction, Endometrial, Iatrogenic, and Not yet classified.
• Distinguishing anovulatory bleeding from other causes requires speculum examination.

Conclusions:

• Accurate diagnosis of AUB relies on detailed history, examination, and classification.
• The PALM-COEIN system provides a standardized framework for understanding and managing AUB.
• Dysfunctional uterine bleeding (DUB) and menorrhagia are now encompassed by the broader term AUB.