Abnormal Uterine Bleeding

Uterine bleeding that is

abnormal in amount, duration
or timing
Terms used to describe
patterns are based on
periodicity and quantity of flow

Types of Abnormal
Bleeding
oligomenorrhe Infrequent, irregular
a
episodes, intervals > 40
days
polymenorrhe
a
hypermenorrh
ea

Frequent, regular episode,

intervals of < 21 days
Excessive in amount
(menorrhagia) and
duration of flow, regular
intervals, >7 days, >80
ml

Types of Abnormal
Bleeding
menometorrhea Excessive and
prolonged, frequent,
irregular interval
hypomenorrhea Regular but decreased in
amount
Intermenstrual Bleeding which is not
bleeding
excessive, occuring
between regular
menstruation

Determine whether
bleeding is:

1. Uterine in origin

2. Organic or not

Through insertion of speculum

Acute cystitis: from urethra
Is there an underlying pathology?
Cervical cancer / polyp

3. Ovulatory or anovulatory

Abnormal Uterine Bleeding

JI Ruby Lyn P. Roque

Prepubertal Age Group

Slight vaginal bleeding within the

first few days of life due to
withdrawal from high levels of
maternal estrogen
Vulvar lesions

Pruritus with excoriations ->

macerations or fissures that can bleed

Prepubertal Age Group

Urethral prolapse

Rare
Bladder mass that is friable and can
bleed slightly
Mass surrounding the urethra
Tx: topical estrogens, urethral biopsy

Prepubertal Age Group

Condyloma

Grapelike growth in cervix and vagina

Child abuse considered
First 2 years of life: acquired
perinatally from mother
Excoriations can produce bleeding

Prepubertal Age Group

Foreign body

Common cause of vaginal discharge,

either purulent or bloody
Possibility of abuse must be
considered

Prepubertal Age Group

Precocious puberty

Vaginal bleeding in the absence of

secondary seual characteristics

Management:

Directed to the cause of bleeding

Persistence of bloody discharge after tx as
a cause of non-specific vulvovaginitis ->
rule out foreign body

Prepubertal Age Group

Trauma

Hx from parents or caretaker to rule out

abuse
Medicolegal case
Straddle injury: affects ant. vulvar area
Sexual abuse: penetrating injury with
lesions of the fourchette or thru hymenal
ring

Prepubertal Age Group

Vaginal tumors

Sarcoma botryoides

Most common
Presents with bleeding and grapelike
clustered mass in vagina

Adolescent Age Group

Normal menses

1st 2 years: most cycles are

anovulatory
2/3 of girls establish pattern within 2
years of menarche
Cycle length: 21 40 days
Mean duration: 4.7 days
Average blood loss : 35 ml / cycle

Adolescent Age Group

Recurrent bleeding of > 80 ml / cycle

anemia
Major component is endometrial
tissue
3 5 pads / day
Cycles > 40 days, < 21 days and
lasting > 7 days are considered
abnormal

Adolescent Age Group

Anovulation

Frequent, prolonged or heavy

bleeding after a long interval of
amenorrhea
The younger the age of menarche,
the sooner ovulation is established

Adolescent Age Group

Pregnancy-related bleeding

Spontaneous abortion, ectopic

pregnancy, molar pregnancy

Exogenous hormones

Breakthrough bleeding in OC users

due to missed pills
DMPA

Adolescent Age Group

Infections

Chlamydial infection can cause postcoital

bleeding

Endocrine or systemic problems

Thyroid dysfunction
Hepatic dysfunction
Polycystic ovarian syndrome
Genital anomalies

Adolescent Age Group

Diagnosis:

Pregnancy test
CBC, plt, CT, BT, coagulation studies
Thyroid function
Test for chlamydia : for sexually active
UTZ : TV / TR

Adolescent Age Group

Management

Mild bleeding : reassurance, close

follow up, supplementation; if mildly
anemic, combination OC or cyclic
progestin
Moderate: combined monophasic OC
q 6H x 4 7 days; MPA 10 30 mg /
day x 7 10 days

Adolescent Age Group

Management

Mild bleeding : reassurance, close

follow up, supplementation; if mildly
anemic, combination OC or cyclic
progestin
Moderate: combined monophasic OC
q 6H x 4 7 days; MPA 10 30 mg /
day x 7 10 days

Adolescent Age Group

Profuse bleeding

Hospitalization
Rule out coagulation disorders

Reproductive Age Group

Dysfunctional Uterine Bleeding

( DUB)

No specific cause
Most often due to anovulation
Low levels of estrogen prolonged
irregular bleeding
High levels of estrogen amenorrhea
followed by acute heavy bleeding

Reproductive Age Group

Pregnancy related
Exogenous hormones
Endocrine
Anatomic and organic causes

Reproductive Age Group

Diagnosis

Blood studies
Pregnancy Test
Pelvic UTZ
Endometrial sampling of D & C or
hysteroscopy

Reproductive Age Group

Management

Non surgical
Surgical

Post Menopausal Age

Benign

HRT
Atrophic vaginitis most common or
endometritis mucosa easily bleeds
Cervical Polyps
Endometrial polyps

Neoplasia

Post Menopausal Age

Daiagnosis

Pelvic examination
PAP smear
Endometrial biopsy / hysteroscopy / D
&C
Transvaginal UTZ

Post Menopausal Age

Management

Atrophic vaginitis estrogen therapy

Polypectomy and curettage

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