Abnormal uterine bleeding aub is a broad term that describes irregularities in the menstrual cycle involving frequency, regularity, duration. Currently, there are no guidelines for comprehensive evaluation and management of dub, and most existing guidelines focus on narrow and specific etiology and age groups. Management choices are determined in partnership with an individual womans need for uterine and fertility preservation. Other causes of abnormal bleeding must also be ruled out, including. Overview of abnormal uterine bleeding in adolescents. Abnormal uterine bleeding aub is bleeding from the uterus that is longer than usual or that occurs at an irregular time. Dysfunctional uterine bleeding dub is a diagnosis of exclusion when there is no pelvic pathology or underlying medical cause. Abnormal uterine bleeding is a frequent condition in gynecology. National collaborating centre for womens and childrens health, national institute of clinical excellence. Joint rcog, bsge and bgcs guidance for the management of.
The clinical approach to abnormal uterine bleeding. Abnormal uterine bleeding aub is a common problem among women in the reproductive age. Abnormal uterine bleeding is a common problem encountered in general practice. Health care practitioners deal with this problem frequently. Abnormal uterine bleeding dysfunctional uterine bleeding ncbi. It is a diagnosis of exclusion made after structural causes of bleeding and chronic medical diseases have been ruled out. Abnormal uterine bleeding aub is an atypical loss of blood from the uterine cavity that occurs outside of the menstrual c ycle. In women of childbearing age, a methodical history, physical examination, and laboratory evaluation may enable. Abnormal uterine bleeding is a diagnosis of exclusion in which there is abnormal bleeding i. Abnormal uterine bleeding aub is defined as changes in frequency of menses, duration of flow or amount of blood loss. In the general population, abnormal uterine bleeding is estimated to affect 11 to percent of reproductive age women at any given time. In postmenopausal women, abnormal uterine bleeding includes vaginal bleeding six months or more after the cessation of menses, or unpredictable bleeding in. Abnormal bleeding persists or intolerant to hormonal therapy. Dysfunctional uterine bleeding dub represents a particular type of abnormal uterine bleeding aub, and is defined in the usa as an excessive, prolonged and irregular bleeding of the endometrium.
Abnormal uterine bleeding aub is a common problem among nonpregnant women in the reproductive age. Michael evans developed the onepager concept to provide clinicians with useful clinical information on primary care topics. Abnormal uterine bleeding occurs when either the frequency or quantity of uterine. Abnormal uterine bleeding british medical bulletin. Abnormal uterine bleeding murtaghs general practice, 7e. Terminologi menoragia saat ini diganti dengan perdarahan haid banyak atau heavy menstrual bleeding hmb.
Continued abnormal bleeding after 6 months bothersome irregular bleeding amenorrhea or scant infrequent bleeding counsel patient that this is expected pattern. Abnormal uterine bleeding symptoms, diagnosis and treatment. One third of outpatient visits to the gynecologist are for aub, and it accounts for more than 70% of all gynecologic consults in the perimenopausal and postmenopausal years 1. Introduction menstruation is considered normal when uterine bleeding occurs every 21 to 35 days and is not excessive. Abnormal uterine bleeding aub is a chronic debilitating condition affecting women worldwide with a significant negative impact on their quality of life. A glossary of italicized words is located at the end of this booklet. Aub leads to loss of productivity1 and may result in surgical interventions including hysterectomy2. Abnormal uterine bleeding has various definitions and. It is responsible for about half of the women with abnormal uterine bleeding in reproductive age ewenstein, 1996. Management of abnormal uterine bleeding in reproductive period. The investigation and management of abnormal uterine bleeding. The evaluation and management of any abnormal uterine bleeding is a complex process involving many decisions being made concurrently. Primary care management of abnormal uterine bleeding. Prevalence of abnormal uterine bleeding according to new.
Endometrial ablation in the management of abnormal uterine. This revision is part of the series, guidelines and recommendations. Evaluation and management of abnormal uterine bleeding. This has been highlighted in the rcog guidelines with an exception of. Abnormal uterine bleeding in patient having thyroid. Keeping current with causes of and treatments for abnormal uterine bleeding aub is important. A classification of abnormal uterine bleeding is presented in table 102. Acute aub refers to an episode of heavy bleeding that, in the opinion of the clinician, is of sufficient quantity to require immediate intervention to prevent further blood loss 1. Management of abnormal uterine bleeding in reproductive. Abnormal uterine bleeding british medical bulletin oxford. As recently defined by the international federation of gynecology and obstetrics figoand endorsed by the american college of obstetricians and gynecologiststhe term abnormal uterine bleeding aub now describes any departure from normal menstrual bleeding. Menstrual flow outside of normal volume, duration, regularity, or frequency is considered abnormal uterine bleeding aub. Abnormal uterine bleeding has been shown to adversely affect mood, energyvitality, work productivity, social interactions, family life and sexual functioning.
Aub can have a major impact on womens lives in terms of health care expenses, productivity, and quality of life. Abnormal vaginal bleeding can relate to an issue with your reproductive system a gynecologic condition or to other medical problems or certain medications. Abnormal uterine bleeding aub is now classified and categorized according to interna tional federation of gynecology and obstetrics guidelines. Abnormal uterine bleeding aub is any variance of the normal menstrual cycle, which is defined on the basis of four parameters frequency, regularity, duration, and volume. These complaints may significantly affect quality of life, result in time off work 14, lead to surgical interventions including hysterectomy 15, and ultimately have a significant. Dysfunctional uterine bleeding is the occurrence of uterine bleeding unrelated to structural abnormalities of the uterus or the endometrial lining. Abnormal uterine bleeding geneva foundation for medical. Although many etiologies cause aub, the one most likely cause among adolescents are dysfunctional uterine bleeding dub. Problem bleeding is among the most common gynecologic complaints of reproductive age women in ambulatory care settingsof similar frequency to the number seeking care for urinary tract infections and vaginitis.
Various charts, questionnaires and diseasespecific patientreported outcome measures proms are available. Aub is regarded as a sign of possible uterine disease, including acute and chronic aub. These problems can occur at any age, but the likely cause of abnormal uterine bleeding usually depends on your age. Up to 30% of women will seek medical assistance for the problem during their reproductive years. Guidelines for the management of abnormal uterine bleeding. Aub frequently coexists with fibroids, but the relationship between the two remains incompletely understood and in many women the identification of fibroids may be incidental to a. Aub may be accompanied by pain and discomfort, cause significant social embarrassment, and have a substantial effect on healthrelated quality of life. Chronic heavy or prolonged uterine bleeding can result in anemia, interfere with daily activities, and raise concerns about uterine cancer. Basic palmcoein classification system for the causes of abnormal uterine bleeding in nonpregnant women of reproductive age.
The mechanisms for the abnormal bleeding and the site from which it arises are largely unknown. Pdf abnormal uterine bleeding aub is a common and debilitating condition with high direct and indirect costs. If you have reached menopause defined as 12 consecutive months, give or take, without a menstrual period subsequent vaginal bleeding may be a cause for concern and should be evaluated. Abnormal uterine bleeding aub is a common and debilitating condition with high direct and indirect costs. Over the history of medicine, there has been a wide range of poorly defined terminology used to describe aub symptoms and etiologies. The association of thyroid disorders with abnormal uterine.
The medical management of abnormal uterine bleeding in. Abnormal uterine bleeding aub is a diagnosis made by a careful process of exclusion which need history, clinical and speculum examination, ultrasound scanning, hysteroscopy endometrial biopsy and laparoscopy. Cer 96 primary care management of abnormal uterine. Abnormal uterine bleeding aub is the most common symptom of gynecological conditions, which is defined as any type of bleeding in which the duration, frequency, or amount is excessive for an individual patient. Aub frequently coexists with fibroids, but the relationship between the two remains. Consider alternate contraceptive method according to patient wishes. Formerly, it was known as dysfunctional uterine bleeding dub. These are just a few of the problems that can cause abnormal uterine bleeding. A common and often debilitating condition, affecting women of reproductive age. Prepared by the vanderbilt evidencebased practice center under contract no. Aub frequently coexists with fibroids, but the relationship between the two remains incompletely understood and in many women the identification of fibroids may be incidental to a menstrual bleeding complaint. Evaluation and management of abnormal uterine bleeding in. It may impact physical, emotional sexual and professional aspects of the lives of women, impairing their quality of life. Management of acute abnormal uterine bleeding in nonpregnant.
Abnormal uterine bleeding is a common problem, and its management can be complex. This system, approved by the international federation of gynecology and obstetrics, uses the term aub paired with descriptive terms that describe associated bleeding patterns hmb or imb, or a qualifying letter or letters, or both to indicate its etiology. Abnormal uterine bleeding a free powerpoint ppt presentation displayed as a flash slide show on id. This chapter examines the modes of presentation and the causes of such symptoms, which range from physiological variations to more sinister underlying pathology. In the treatment of women with abnormal uterine bleeding, once a thorough history, physical examination, and indicated imaging studies are performed and all significant structural causes are excluded, medical management is the firstline approach. Abnormal uterine bleeding aub atau perdarahan uterus. Ppt abnormal uterine bleeding powerpoint presentation. Abnormal uterine bleeding aub may be acute or chronic and is defined as bleeding from the uterine corpus that is abnormal in regularity, volume, frequency, or duration and occurs in the absence of pregnancy 1 2.
Abnormal bleeding caused by hormone imbalance is more common in teenagers or in women who are approaching menopause. Abnormal uterine bleeding aub in nonpregnant reproductiveage women is a common gynecologic symptom. Diagnosis of abnormal uterine bleeding in reproductiveaged. Figo classification system palmcoein for causes of abnormal. Abnormal uterine bleeding is a common but complicated clinical presentation, accounting for at least 20% of all new outpatient visits 12. Abnormal uterine bleeding and uterine fibroids page 2 of 19 unitedhealthcare commercial medical policy effective 04012020 proprietary information of unitedhealthcare. Abnormal uterine bleeding obstetrics and gynecology clinics. Jan 01, 2012 abnormal uterine bleeding occurs in 9 to 14 percent of women between menarche and menopause, significantly impacting quality of life and imposing financial burden.
Bleeding may be heavier or lighter than usual and occur often or randomly. In cases of acute and severe bleeding, women may need urgent treatment with. Dysfunctional uterine bleeding describes the sp ectrum of abnormal bleeding patterns in the abscence of a medical illness or pelvic pathology. Miscarriage ectopic pregnancy adenomyosis use of some birth control methods, such as an intrauterine device iud or birth control pills infection of the uterus or cervix fibroids problems with blood clotting. Chronic heavy or prolonged uterine bleeding can result in anemia, interfere with daily activities, and raise concerns about. Diagnosis of abnormal uterine bleeding in reproductive. Aub is responsible for significant health problem and social embarrassment and it is one of the common reasons women seek health care. Dub is typically characterized by heavy prolonged flow with or without breakthrough bleeding. Heavy menstrual bleeding is the commonest cause of irondeficiency anaemia in the western world. Primary care management of abnormal uterine bleeding aub. The normal duration of menstrual bleeding is between two and seven days. Abnormal uterine bleeding is a broad term that indicates a change in frequency of menses, duration of flow or amount of blood loss. Abnormal uterine bleeding national health portal of india. Abnormal uterine bleeding is one of the most common reasons for women to seek for care.
Abnormal uterine bleeding is an extremely common indication for referral to a gynaecologist. This will depend on the cause of the abnormal uterine bleeding if a chronic illness or a blood disorder is at the root of your symptoms, treating that can help. A systematic approach to aub evaluation can simplify management and enhance womens wellbeing. Abnormal uterine bleeding aub is a frequent cause of visits to health care provider during adolescent period and is characterized by irregular, excessively heavy, prolonged andor frequent bleeding of uterine origin. Abnormal uterine bleeding describes any variation from normal. Abnormal uterine bleeding and uterine fibroids commercial. Abnormal uterine bleeding aub is a condition that affects approximately 30% of women during their reproductive years. Abnormal uterine bleeding aub is a common condition that leads to increased health care costs and decreased quality of life. Aub can have a major impact on womens lives in terms of health care. Clinical practice clinical update dysfunctional uterine. Abnormal uterine bleeding is a common presenting symptom in the family practice setting. Because of this complexity, concise guidelines have been difficult to develop. The first step in the diagnostic workup is to assess the quantity of menstrual blood loss and the impact on the patient.
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