Abnormal Uterine Bleed Notes

pathologynuggets.blogsspot.com notes on AUB.

Abnormal uterine bleeding can be either Heavy menstrual bleed or Intermenstrual bleeding.

In heavy menstrual bleeding, there is excessive or prolonged bleeding during periods. It occurs during regular menstrual cycles.
In contrast, bleeding occurs irregularly between menstrual cycles, in intermenstrual bleeding.

If A is one cycle and B is the next menstrual cycle, in HMB, heavy bleeding or an increased amount of bleed occurs in these regular cycles, while in intermenstrual bleeding, the bleeding occurs, in between, these cycles.
Other types of abnormal bleeding include post-coital bleed and postmenopausal bleeding.

AUB mnemonic

One of the classification systems for AUB is the mnemonic PALM COEIN.

Among these, PALM represents structural causes, and COEIN represents non-structural causes.

PALM stands for polyp, adenomyosis, leiomyoma, and malignancy
Similarly, COEIN stands for coagulopathy, ovulatory cause, endometrial, iatrogenic, or cause not classified.

Based on the age group of the patient, abnormal uterine bleeding has different causes.
In premenopausal, some of the causes include foreign body, sexual abuse, precocious puberty, and sarcoma botryoid.
Similarly, in women of reproductive age, causes can be related to pregnancy. Thus, a beta HCG test is commonly ordered in these patients.
In postmenopausal females, the most common cause of abnormal uterine bleeding is atrophic vaginitis. It occurs due to loss of estrogen after menopause, resulting in drying and atrophy of vaginal dermal tissue. In these patients, endometrial carcinoma should be ruled out with endometrial biopsy.

Review Questions:

Question 1. COEIN in the PALM COEIN system of classification of abnormal uterine bleeding represents structural causes. (True/False) ..................

Question 2. Which investigation is indicated in post-menopausal bleeding?

Question 3. What do you mean by dysmenorrhea? ...........

Video lesson on abnormal uterine bleeding:

Answers:

1. False. PALM represents structural causes.

2. Endometrial biopsy
3. Dysmenorrhea is defined as "painful bleeding." Some of the causes of dysmenorrhea include endometriosis, adenomyosis, PID, cervical stenosis, etc.

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