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Review
. 2017 Sep 1;123(1):103-114.
doi: 10.1093/bmb/ldx027.

Abnormal uterine bleeding

Ying Cheong  1   2 , Iain T Cameron  1   2 , Hilary O D Critchley  3
Affiliations
Review

Abnormal uterine bleeding

Ying Cheong et al. Br Med Bull. .

Erratum in

  • Abnormal uterine bleeding.
    Cheong Y, Cameron IT, Critchley HOD. Cheong Y, et al. Br Med Bull. 2019 Sep 19;131(1):119. doi: 10.1093/bmb/ldz008. Br Med Bull. 2019. PMID: 31220225 No abstract available.

Abstract

Introduction: It is not uncommon for a woman to suffer from abnormal uterine bleeding (AUB) or heavy menstrual bleeding (HMB) at some point during her lifetime. Once pathology is excluded, in practice, management needs to be individualised, taking into account the improvement of the woman's symptoms and quality of life.

Sources of data: Peer-reviewed journals, governmental and professional society publications.

Areas of agreement: There is now agreement on a structured, universal approach to the diagnosis of AUB, with the aide memoirs PALM (polyps, adenomyosis, leiomyoma, malignancy) and COEIN (coagulopathies, ovulatory dysfunction, endometrial, iatrogenic, not otherwise classified). Once malignancy and significant pelvic pathology have been ruled out, medical treatment is an effective first-line therapeutic option, with surgery, including endometrial ablation and hysterectomy, offered when medical management has failed to resolve symptoms and fertility is no longer desired.

Areas of controversy: There remains controversy around the management of the types and subtypes of adenomyosis and leiomyoma, and understanding their impact on clinical reproductive outcomes.

Areas currently under development: Standardised assessment tools for measuring outcomes of AUB are being developed.

Areas timely for developing research: Novel diagnostic and monitoring tools should be developed to help stratify treatment for women with AUB, particularly relating to 'unclassified' and 'endometrial' causes.

Keywords: abnormal menstrual bleeding; dysfunctional menstrual bleeding; heavy menstrual bleeding; menstruation.

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