April 2002 · Vol. 14, No. 4Abnormal uterine bleeding:
A Quick Guide To Evaluation And Treatment
After vaginitis, abnormal bleeding is the main reason women consult a gynecologist. Fortunately, the armamentarium is as broad as the range of etiologies.
LINDA
D.
BRADLEY,
MDDr. Bradley is director of hysteroscopic services, department of OBG, at the Cleveland Clinic Foundation in Cleveland, Ohio. She also serves on the OBG Management board of editors.
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Key points
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Approximately 15% to 20% of office gynecologic visits are for the evaluation of abnormal uterine bleeding (AUB), and 25% to 50% of gynecologic surgeries are performed to address menstrual dysfunction.
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Office hysteroscopy and saline infusion sonography are essential skills for the practicing gynecologist. Learn them and use them liberally.
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Inherited and acquired disorders of coagulation, as well as liver and renal diseases, frequently present with symptoms of abnormal uterine bleeding.
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Liberal use of endometrial biopsy is encouraged in women over 35 years of age at risk for endometrial hyperplasia and cancer.
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About 20% to 30% of teens with irregular heavy menses have a major bleeding diathesis.
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Medical therapy is the standard unless uterine pathology is present.
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Half of all hysterectomies in the United States are performed to treat abnormal uterine bleeding. Of these, approximately 20% are performed in women with a normal uterine size.1 However, when the uterus appears normal, without adenomyosis or uterine pathology, it is imperative that the clinician perform a thorough evaluation before resorting to hysterectomy.
Abnormal uterine bleeding is defined as excessive, erratic, or irregular bleeding in the presence or absence of intracavitary or uterine pathology. It may be associated with structural or systemic abnormalities. In contrast, dysfunctional uterine bleeding (DUB) is associated with anovulatory menstrual cycles. It is not caused by pelvic pathology, medications, systemic disease, or pregnancy.
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