AUTHORS: Sydney Ford, MD, MPH and Siri M. Holton, MD
Abnormal uterine bleeding (AUB) describes uterine bleeding that is abnormal in regularity, quantity, frequency, or duration, in the nonpregnant person. Historically, AUB was described as in Table 1. The term dysfunctional uterine bleeding was applied when no clear etiology could be identified. These terms have fallen out of favor. In 2011, the FIGO Working Group on Menstrual Disorders released a classification system intended to simplify these definitions. It is known by the acronym PALM-COEIN, which is further described later. This classification system divides the causes of AUB into two groups: structural (PALM) and nonstructural (COEIN). Today, AUB is described according to these criteria.
TABLE 1 Definitions of Abnormal Uterine Bleeding
Term | Description | ||
---|---|---|---|
Oligomenorrhea | Bleeding at intervals greater than 35 days | ||
Polymenorrhea | Bleeding at intervals less than 21 days | ||
Hypermenorrhea (menorrhagia) | Excessive flow or bleeding with normal intervals | ||
Metrorrhagia | Bleeding between menses | ||
Menometrorrhagia | Excessive flow or duration with periods and between periods | ||
Withdrawal bleeding | Bleeding after the withdrawal of hormones |
From Crum CP et al: Diagnostic gynecologic and obstetric pathology, ed 3, Philadelphia, 2018, Elsevier.
A normal menstrual cycle is typically described as lasting 21 to 35 days with up to 7 days of bleeding per cycle. Total blood loss for normal menses is thought to be less than 80 mL.
Abnormal uterine bleeding (AUB)
Dysfunctional uterine bleeding
|
TABLE 2 Causes of Abnormal Uterine Bleeding
Age (Years) | Differential Diagnosis | ||
---|---|---|---|
Prepubertal | Precocious puberty (hypothalamic, pituitary, ovarian) | ||
Adolescence | |||
Third and fourth decades | |||
Fifth decade | |||
Sixth decade |
From Crum CP et al: Diagnostic gynecologic and obstetric pathology, ed 3, Philadelphia, 2018, Elsevier.
Patient education material may be obtained from the American College of Obstetricians and Gynecologists, 409 12th Street SW, Washington, DC, 20024-2188; phone 202-638-5577.
Abnormal Uterine Bleeding (Patient Information)
Endometrial Cancer (Related Key Topic)
Heavy Menstrual Bleeding (Menorrhagia) (Related Key Topic)
Uterine Fibroids (Related Key Topic)