ABNORMAL

UTERINE BLEEDING
RAKSHANA R
FINAL YEAR MBBS
ABNORMAL UTERINE BLEEDING

• Any uterine bleeding outside the normal volume, duration, regularity or

frequency is considered abnormal uterine bleeding.
• Acute AUB is an episode of heavy bleeding which is of sufficient quantity
to require medical intervention to prevent further blood loss.
• Chronic AUB is defined as bleeding from uterine corpus which is
abnormal in duration, volume, frequency and has been present for 6
months.
PATTERNS OF AUB

•Mennorhagia is defined as cyclic bleeding at normal intervals,the bleeding is either excessive in amount or
duration or both.
•Polymenorrhoea is defined as cyclic bleeding where the cycle is reduced to less than 21 days and remains
constant in frequency.
•Metrorrhagia is defined as irregularly timed episodes of bleeding superimposed on normal cyclical bleeding.
•Menometrorrhagia is defined as excessive and prolonged bleeding that occurs that occurs at irregularly timed
and frequent intervals.
•Oligomenorrhea is defined as menstrual bleeding occuring more than 35 days and remains constant in
frequency.
•Hypomenorrhea is defined as menstrual bleeding which is scanty and lasts for less than 2 days.
PATHOGENESIS

• Anovulatory cycles (80%)

• Ovulatory cycles (20%)
ANOVULATORY CYCLES

• Anovulatory bleeding is usually excessive.

• Absence of progesterone due to anovulation.
• The endometrial growth is under the influence of estrogen throughout the
cycle. There is inadequate structural stromal support and the endometrium
remains fragile.
• With the withdrawal of estrogen due to negative feedback action of FSH,
the endometrial shedding continues for a longer period.
METROPATHIA HEMORRHAGICA

• Specialized form of anovulatory AUB, seen in women between 40 and 45.

• Continuous painless vaginal bleeding preceded by 6-8 weeks of
Amennorrhoea.
• Simulates abortion and ectopic pregnancy, but pain is conspicuously absent.
• Changes in the uterus – variable degree of myohyperplasia with
symmetrical enlargement of uterus to a size of about 8-10 weeks.
METROPATHIA HEMORRHAGICA

• Microspically – Endometrium shows cystic glandular hyperplasia giving characteristic

swiss cheese appearance, absence of secretory changes and areas of necrosis in the
superficial layers with small hemorrhages and leukocytic infiltration.
OVULATORY CYCLES

• Irregular ripening
-Poor formation of corpus luteum and inadequate function leads to inadequate
production of progesterone, which is inadequate to support endometrial growth.
- slight bleeding or spotting starts before regular periods.
• Irregular shedding
- Incomplete atrophy of Corpus luteum results in persistent secretion of
Progesterone.
- Bleeding or spotting continues for variable periods after regular periods.
CAUSES OF AUB - ADOLESCENTS

• Immature hypothalamo pituitary ovarian axis.

• Blood dyscrasia – such as Von Willebrand disease, ITP
• PCOD
• Hypothyroidism
• Genital tuberculosis
• Liver disorders
• Feminizing ovarian tumors
CAUSES OF AUB – REPRODUCTIVE AGE GROUP

• Anovulatory cycles
• Thyroid disorder
• PCOD
• Pregnancy related complications
• Problems related to contraception
• Fibroid, adenomyosis, ovarian tumors, PID
CAUSES OF AUB – PERIMENOPAUSAL AGE
GROUP
• Anovulatory bleeding due to depletion of ovarian follicles
• Malignant conditions of uterus, cervix,ovary
• Thyroid disorders
• Fibroid, adenomyosis, endometriosis, PID
PALM COEIN CLASSIFICATION

• Structural causes – PALM

P – Polyp
A – Adenomyosis
L – Leiomyoma
M – Malignancy and Premalignant lesions
PALM COEIN CLASSIFICATION

• Non structural causes – COEIN

C – Coagulopathy
O – Ovulatory dysfunction
E – Endometrial causes
I – Iatrogenic
N – Not classified
THANK YOU