Transcript Abnormal Uterine Bleeding

Abnormal Uterine Bleeding
A new classification system
Abnormal Uterine Bleeding
• Overarching term for the symptom of
disturbed menstral bleeding
• Discarded terms
– DUB
– Menorrhagia
• AUB will be subdivided by causes such as
polyps, ovulation disorders, etc
PALM-COEIN
• P
– Polyps either endometrial or endocervical
– AUB-P
• A
– Adenomyosis
– AUB-A
• L
– Leiomyoma
– AUB-L
PALM-COEIN
• M
– Malignancy/hyperplasia
– AUB-M
• C
– Coagulopathy either from clinical disorder or from
anticoagulant medication
– AUB-C
• O
– Ovulatory disorders
– AUB-O
PALM-COEIN
• E
– Endometrial disorders
– AUB-E
• I
– Iatrogenic
– AUB-I
• N
– Non yet classified
– AUB-N
Patient with AUB
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•
•
•
Could they be anemic
Are they on a drug that could cause AUB
Are they ovulatory
Are they at risk of hyperplasia/malignancy
Chronic AUB: =3 months of disturbed menstrual bleeding
Are they on a drug
that could cause
AUB?
Are they ovulatory
No
AUB-O
CBC
Could they be anemic?
No
Yes
Yes
AUB-I
Are they at risk for
malignancy/hyperplasia
Evaluate the
uterus
AUB-C
yes
Endometrial
sampling
Ultrasound, sonohysterogram, hysteroscopy
negative
AUB-E
AUB-A
AUB-M
Positive
AUB-P
AUB-L
AUB-I
• Hormonal contraception
• IUD
• Tricyclic antidepressants, phenothiazines
AUB-C
• Anticoagulant meds
• coagulopathies
Chronic AUB: =3 months of disturbed menstrual bleeding
Are they on a drug
that could cause
AUB?
Are they ovulatory
No
AUB-O
CBC
Could they be anemic?
No
Yes
Yes
AUB-I
Are they at risk for
malignancy/hyperplasia
Evaluate the
uterus
AUB-C
yes
Endometrial
sampling
Ultrasound, sonohysterogram, hysteroscopy
negative
AUB-E
AUB-A
AUB-M
Positive
AUB-P
AUB-L
AUB-O
•
•
•
•
•
•
Most of the time no etiology
PCOS
Hypothyroid
Hyperprolactinemia
Mental stress
Extreme changes in weight or exercise
Chronic AUB: =3 months of disturbed menstrual bleeding
Are they on a drug
that could cause
AUB?
Are they ovulatory
No
AUB-O
CBC
Could they be anemic?
No
Yes
Yes
AUB-I
Are they at risk for
malignancy/hyperplasia
Evaluate the
uterus
AUB-C
yes
Endometrial
sampling
Ultrasound, sonohysterogram, hysteroscopy
negative
AUB-E
AUB-A
AUB-M
Positive
AUB-P
AUB-L
Posterior Fibroid
Slide courtesy of Linda Darlene Bradley, MD.
Saline Infusion Sonography
Posterior Class 3 Fibroid
Slide courtesy of Linda Darlene Bradley, MD.
Endometrial Polyps
Slide courtesy of Linda Darlene Bradley, MD.
Endometrial Polyps
Slide courtesy of Linda Darlene Bradley, MD.
Chronic AUB: =3 months of disturbed menstrual bleeding
Are they on a drug
that could cause
AUB?
Are they ovulatory
No
AUB-O
CBC
Could they be anemic?
No
Yes
Yes
AUB-I
Are they at risk for
malignancy/hyperplasia
Evaluate the
uterus
AUB-C
yes
Endometrial
sampling
Ultrasound, sonohysterogram, hysteroscopy
negative
AUB-E
AUB-A
AUB-M
Positive
AUB-P
AUB-L
Possible Endometrial Biopsy Findings
• Proliferative, secretory, benign, or atrophic
endometrium
• Inactive endometrium
• Tissue insufficient for analysis
• No endometrial tissue seen
• Simple or complex hyperplasia without atypia
• Simple or complex hyperplasia with atypia
• Endometrial adenocarcinoma
Chronic AUB: =3 months of disturbed menstrual bleeding
Are they on a drug
that could cause
AUB?
Are they ovulatory
No
AUB-O
CBC
Could they be anemic?
No
Yes
Yes
AUB-I
Are they at risk for
malignancy/hyperplasia
Evaluate the
uterus
AUB-C
yes
Endometrial
sampling
Ultrasound, sonohysterogram, hysteroscopy
negative
AUB-E
AUB-A
AUB-M
Positive
AUB-P
AUB-L
AUB-A
• Adenomyosis usually found on hysterectomy
specimen
• MRI
AUB-E
• Problem with prostiglandins
• Receptor problems
• Areas for research