Abnormal Bleeding Fibroids
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Abnormal Uterine bleeding (AUB)
Abnormal bleeding from the uterus is one of the commonest problems that come to gynecology OPD.It may happen in any age group starting from adolescence to perimenopause to even post menopausal bleeding.
Its prevalence in India is 17.9%.It is important to know what is normal and what needs treatment.
| Clinical Parameter | Descriptive term | Normal limits (5–95th percentiles) |
|---|---|---|
| Frequency of menses (days) | Frequent Normal Infrequent | <24 24–38 >38 |
| Regularity of menses, cycle to cycle (Variation in days over 12 months) | Absent Regular Irregular | No bleeding Variation ± 2–20 days Variation >20 days |
| Duration of flow (days) | Prolonged Normal Shortened | >8.0 4.5–8.0 <4.5 |
| Volume of monthly blood loss (mL) | Heavy Normal Light | >80 5–80 <5 |
The International Federation of Gynecology and Obstetrics ( FIGO 2011) has classified abnormal bleeding by PALM-COEIN method to facilitate accurate diagnosis.
There could be many reasons for abnormal bleeding eg.
The management of AUB depends on mainly the age of the woman and the severity of the problem.
The most common reasons for abnormal cycles could be stress and anxiety which could make the cycles irregular.
Sometimes taking an emergency contraceptive pill could cause abnormal bleeding.
After evaluating the history, usually some investigations are suggested.
A biopsy of the endometrium is recommended in most cases if
Endometrial aspiration and not Dilatation and curettage should be the preferred procedure Ideally we should obtain an endometrial sample only in the context of diagnostic hysteroscopy instead of a ‘blind’ endometrial biopsy in women with Heavy menstrual bleeding.
There is now an increased availability of medical options for management of AUB and we try the more conservative approach available. The choice of treatment depends on factors like
| Etiology | Treatment | ||
|---|---|---|---|
| Polyp | Hysteroscopic surgical removal Multiple polyps or polypoidal endometrium and fertility is not desired– LNG-IUS can be combined with surgical removal | ||
| Adenomyosis | LNG-IUS, if LNG IUS is not accepted– GnRH agonists with add back therapy; if it fails OCP, NSAIDs, progestogens | ||
| Malignancy | Atypical endometrial hyperplasia– surgical treatment fertility not desired– hysterectomy Hyperplasia without atypia LNG-IUS followed by oral progestins or PRMs | ||
| COEIN | LNG-IUS or tranexamic acid, NSAIDs, followed by COCs or cyclic oral progestins Medical or surgical treatment failed or contraindicated: GnRH agonists with add-back hormone therapy When steroidal and other options unsuitable: Centchroman | ||
| Intramural or subserosal myomas (grade 2-6) | |||
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