ABNORMAL UTERINE

BLEEDING (AUB) UTERINE

BLEEDING
 AUB
 Defined as bleeding from the uterine corpus that is abnormal in
duration, volume, frequency, and/ or regularity in a non-pregnant
woman.
 CHRONIC AUB- abnormal bleeding that has been present for the
majority of the preceding 6 months
 ACUTE AUB- an episode of heavy bleeding that, in the opinion of
a clinician, is of sufficient quantity to require immediate
intervention. It may occur in woman with existing chronic AUB.
Terminology and nomenclature by FIGO

 In 2011
FIGO AUB SYSTEM 1 - nomenclature and definitions of
normal and abnormal uterine bleeding (AUB) in the
reproductive years.
FIGO AUB SYSTEM 2 (PALM - COEIN)-classification
of causes of AUB.
 In 2018 - modifications done
 FIGO AUB SYSTEM 1
Terminologies and definitions based on characteristics of 4
components of normal menstruation.
1. Frequency
2. Duration
3. Regularity
4. Volume of blood loss
parameters

FREQUENCY • ABESENT
• INFREQUENT (>38 DAYS)
• NORMAL (24- 38 DAYS)
• FREQUENT (<24 DAYS)
DURATION • Normal (<or = 8 days)
• Prolonged (>8 days)

REGULARITY • Regular/ normal – 7 to 9 days 18 to 25 y - </= 9 days

(SHORTEST TO 26- 41 y - </= 7 days
LONGEST CYCLE 42 – 45 y- </= 9 days
VARIATION) • Irregular - >8-10 days
VOLUME • Light
(PATIENT • Normal
DETERMINED) • heavy
 Abandoned terminologies like dysfunctional uterine bleeding,
menorrhagia, metorrhagia, oligomenorrhea etc

 NICE definition for HMB

 Definition for IMB

HEAVY MENSTRUAL BLEEDING [HMB]
(NICE definition– NATIONAL INSTITUTE OF HEALTH AND CLINICAL
EXCELLENCE)

 Excessive menstrual blood loss which interferes with woman’s

physical ,social, emotional and/ or material quality of life.
INTERMENSTRUAL BLEEDING (IMB)

 Bleeding between clearly defined cyclic predictable menses and

replaces the term metrorrhagia.
 These can occur randomly or at regular time in each cycle
PARAMETER NORMAL FIGO SYSTEM 1 MODIFICATIONS TO FIGO
2011 SYSTEM 1 (2018)

DURATION OF FLOW 4.5 to 8 DAYS Prolonged Normal < 8 days

Normal Prolonged > 8 days
Shortened

FREQUENCY 24 TO 38 DAYS Frequent (<24 days) Amenorrhea is included in

Normal frequency category
Infrequent (>38 days)

REGULARITY (CYCLE TO CYCLE 2 TO 20 DAYS Regular regular ( shortest to longest

VARIATION) Irregular cycle variation: < 7-9 days)
Absent Irregular ( shortest to longest
cycle variation: ≥ 8-10 days)

VOLUME OF BLOOD LOSS 5 TO 80 ML Heavy NICE definition of HMB

Normal
Light

INTERMENSTRUAL BLEEDING IMB - definition added

FIGO AUB SYSTEM 2
 Classification based on clinical and imaging based stratification of
causes :

PALM – “STRUCTURAL” pathologies

 Polyp
 Adenomyosis
 Leiomyoma
 Malignancy or atypical endometrial hyperplasia
COEIN - “NON STRUCTURAL”
That cannot be imaged, but clinical assessment with detailed history and
physical examination, laboratory testing, can make a diagnosis of causes
 Coagulopathies
 Ovulatory disorders
 Primary endometrial disorders
 Iatrogenic
 Not otherwise classified – spectrum of potential entities that may or may
not be measured or defined by histopathology or imaging techniques
CHANGES IN FIGO SYSTEM 2 (2018)

AUB-A Refined sonographic diagnostic criteria

(ADENOMYOSIS)

AUB-L Inclusion of type 3 as a submucous leiomyoma

(LEIOMYOMA) Type definitions and distinctions, distinctions between type 0 and 1, 6 and 7

AUB-C No longer includes AUB associated with pharmacological agents that impair blood
(COAGULOPATHY) coagulations which are now included in AUB-I

AUB-I Now includes AUB associated with all iatrogenic processes including the use of
(IATROGENIC) pharmacological agents used for anticoagulation and those thought to interfere the
ovulation

AUB-O Diagnostic threshold changes based upon the revisions of system 1, described above.
(OVULATORY) No longer includes ovulatory disorders associated with drugs known or suspected to
interfere with ovulation

AUB-N The name changed from “ not yet classified “ to “not otherwise classified”.
(NOT OTHERWISE Brief discussion of a potential new cause of AUB the so called uterine “niche” or
CLASSIFIED) isthmocele following lower segment cesarean section.
- type 3 as submucous myoma
- Type 0 and 7 – stalk diameter </= 10% of mean diameter of
myoma.
 NOTATION

 If any component present – represent as 1 , if absent – represent

as 0.

For eg : P0A0L1M0 C0O0E0I0N0 OR AUB- L

 IF 2 components present,
Eg : P0A1L1M0 C0O1E0I0 N0 or as AUB A-L-O
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