Abnormal Uterine Bleeding A new classification system.
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Transcript of 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
Patient with AUB
• 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?
Yes
AUB-I AUB-C
No
Are they ovulatory
No
AUB-O
Yes
Evaluate the uterus
Ultrasound, sonohysterogram, hysteroscopy
negative
AUB-E
AUB-A
Are they at risk for malignancy/hyperplasia
yes
Endometrial sampling
AUB-M
Could they be anemic? CBC
Positive
AUB-P AUB-L
Chronic AUB: =3 months of disturbed menstrual bleeding
Are they on a drug that could cause
AUB?
Yes
AUB-I AUB-C
No
Are they ovulatory
No
AUB-O
Yes
Evaluate the uterus
Ultrasound, sonohysterogram, hysteroscopy
negative
AUB-E
AUB-A
Are they at risk for malignancy/hyperplasia
yes
Endometrial sampling
AUB-M
Could they be anemic? CBC
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?
Yes
AUB-I AUB-C
No
Are they ovulatory
No
AUB-O
Yes
Evaluate the uterus
Ultrasound, sonohysterogram, hysteroscopy
negative
AUB-E
AUB-A
Are they at risk for malignancy/hyperplasia
yes
Endometrial sampling
AUB-M
Could they be anemic? CBC
Positive
AUB-P AUB-L
Chronic AUB: =3 months of disturbed menstrual bleeding
Are they on a drug that could cause
AUB?
Yes
AUB-I AUB-C
No
Are they ovulatory
No
AUB-O
Yes
Evaluate the uterus
Ultrasound, sonohysterogram, hysteroscopy
negative
AUB-E
AUB-A
Are they at risk for malignancy/hyperplasia
yes
Endometrial sampling
AUB-M
Could they be anemic? CBC
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?
Yes
AUB-I AUB-C
No
Are they ovulatory
No
AUB-O
Yes
Evaluate the uterus
Ultrasound, sonohysterogram, hysteroscopy
negative
AUB-E
AUB-A
Are they at risk for malignancy/hyperplasia
yes
Endometrial sampling
AUB-M
Could they be anemic? CBC
Positive
AUB-P AUB-L