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Abnormal uterine bleeding

P I Wathen1, M C Henderson, C A Witz

  • 1Division of General Internal Medicine, University of Texas Health Science Center, San Antonio.

The Medical Clinics of North America
|March 1, 1995
PubMed
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Abnormal menstrual bleeding evaluation begins with assessing ovulation. Treatment varies from oral contraceptives (OCPs) to addressing underlying causes like coagulopathies or structural lesions.

Area of Science:

  • Gynecology
  • Primary Care Medicine
  • Reproductive Endocrinology

Background:

  • Abnormal menstrual bleeding is a frequent gynecological concern prompting primary care visits.
  • Initial evaluation focuses on determining the patient's ovulatory status.

Purpose of the Study:

  • To outline the diagnostic and management strategies for various types of abnormal uterine bleeding.
  • To differentiate between ovulatory and anovulatory bleeding and guide appropriate interventions.

Main Methods:

  • Clinical evaluation including history, physical examination, and laboratory tests.
  • Assessment of ovulatory status as the primary diagnostic step.
  • Differential diagnosis considering structural lesions, coagulopathies, hypothyroidism, and anovulatory causes.

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Main Results:

  • Heavy bleeding with normal cycles requires evaluation for systemic or structural causes; menorrhagia may be treated with OCPs or NSAIDs.
  • Intermenstrual bleeding can stem from OCP noncompliance, low-dose pills, or structural/inflammatory lesions.
  • Anovulatory bleeding necessitates ruling out pregnancy, systemic illness, and structural issues; endometrial biopsy is indicated for specific risk groups.

Conclusions:

  • Dysfunctional uterine bleeding, often linked to anovulation, affects adolescents and perimenopausal women due to hormonal fluctuations and lifestyle factors.
  • Management includes hormonal therapies like OCPs, cyclic progesterone, or hormone replacement.
  • Referral to a gynecologist is crucial for persistent or complex cases unresponsive to initial treatment.