1.

5 Addendum
Abnormal Uterine Bleeding (additional
notes)
Dr. Teresita Cadiz-Brion, MD, FPOGS 29 July 2015
DIAGNOSIS
 Endocrinopathies: PCOS, hypothyroidism,
Pelvic exam: speculum and bimanual examination to define the
hyperprolactenemia, mental stress, obesity, anorexia,
etiology of vaginal bleeding
weight loss or extreme exercise
 Trauma to the vaginal walls or cervix
 Unexplained ovulatory disorders frequently occur at
 Foreign body
extremes of reproductive age: adolescence and
 Cervical or vaginal laceration
menopausal transition
 Bleeding from the os
 In USA, ovulatory disorders comprised the vast
 Uterine or ovarian structural abnormalities
majority of cases encompassed by the now-discarded
term “DUB”
Initial evaluation should be directed at assessing patient’s blood
 Disorders of ovulation present as a spectrum of
volume status and degree of anemia
menstrual abnormalities (amenorrhea, extremely light
& infrequent bleeding, to episodes of unpredictable and
Patients with hematologic pathology also may have cutaneous
extreme HMB)
evidence of bleeding diarthesis:
 Petechiae
IATROGENIC (AUB-I)
 Purpura
 Medicated or inert intrauterine systems and
 Mucosal bleeding
pharmacologic agents taht directly impact the
endometrium, interfere with blood coagulation
DIAGNOSTIC PROCEDURE
mechanism, or influence the systemic control of
PELVIC ULTRASONOGRAPHY (TSS, TVS, TRS)
ovalution
 To evaluate structural lesions that may cause abnormal  Hormonal contraceptives (oral, transdermal/vaginal,
vaginal bleeding and injectable progestin or estrogen-progestin
 Fibroids, ONG, PCOS compounds), L-IUS
 Antidepressants, anticoagulants
DILATATION AND CURETTAGE (D&C)
 Can be both therapeutic and diagnostic ENDOMETRIAL (AUB-E)
 TOC when bleeding is severe  A primary disorder of the endometrium when AUB
 Allows more extensive sampling of the uterine cavity occurs in a predictable and cyclic manner, typical of
 Best reserved for older patients ovulatory cycles, without other definable causes
 If symptom is HMB, may be a primary disorder of
HYSTEROSCOPY SALPHINGOSONOGRAPHY (HSS) mechanisms regulating local endometrial “hemostasis”
 Use of saline solution itself.
 Look for patency of fallopian tube  Diagnosis of endometrial disorders should be
determined by exclusion of other identified
PALM-COIEN CLASSIFICATION abnormalities in women of reproductive age with
POLYP (AUB-P) normal ovulatory function.
 Present or absent  Deficienct production of vasoconstrictiors (endothelin-1
 Defined by 1 or combination of UTZ and prostaglandin F2a)
 Accelerated lysis of endometrial clot due to excessive
ADEMOMYOSIS (AUB-A) production of plasminogen activator
 UTZ criteria for adenomyosis  Increased local production of vasodilators
o Minimum requirement for assigning the diagnosis (Prostaglandin E2 and prostacyclin I2)
of ademyosis in PALM-COIEN classification
 UTZ apparenace is partly related to the absolute NOT YET CLASSIFIED (AUB-N)
presence of heterotopic endometrial tissue in the  Poorly defined entities: chronic endometritis,
myometrium and partly due to the related myometrial arteriovenous malformations and myometrial
hypertrophy hypertrophy
 Other disorders, not yet identified, that would be
LEIOMYOSIS (AUB-L) defined only by biochemical or molecular biology
 More accurate term, selected for use in the assays
classification system  With future evidence, may be allocated a separate
 Due to its high prevalence, varied size, location and category or be placed into an existing category in the
number of lesions—separate categorization in the system
system
 Many are asymptomatic; often their presence is not the MORTALITY AND MORBIDITY
cause of AUB  Morbidity and mortlity is related to the amount of blood
loss at the time of menstruation
MALIGNANCY AND HYPERPLASIA (AUB-M)  IDA/ iron deficiency anemia
 When a premalignant hyperplastic or malignant - Persistent menstrual disturbances might lead to
process is identified during investigation of women with chronic iron loss
AUB, it would be classified as AUB-M, then  DUB in itself is rarely fatal
subclassified using the appropriate WHO FIGO system - Development of endometrial cancer is related to
estrogen stimulation and endometrial hyperplasia
COAGULOPATHY (AUB-C) - Symptoms include postmenopausal bleeding,
 Encompasses the spectrum of systemic disorders of which is usually considered cancer until proven
hemostasis that may be associated with AUB otherwise
 13% of women with HMB have biochemically
detectable systematic disorders of hemostasis (von
willebrand disease)

OVULATORY DYSFUNCTION (AUB-O)

 Absence of predictable cyclic progesterone production
from the corpus luteum
 In later reproductive years may relate to unusual
“disturbed” ovulations (luteal out of phase events)

Transcribers: ADAYA, BERNARDO, FERMIN, LAGMAY, PAGADOR Page 1 of 1