disorders of menstruation

Understand the symptoms and etiology of abnormal uterine bleeding (AUB).
• Describe the terminology of AUB.
• Understand the symptoms, investigation and management of heavy menstrual bleeding (HMB).
• HMB: excessive menstrual blood loss
• IMB: bleeding between periods, often seen with endometrial and cervical polyps also endometriosis
• PCB: bleeding after sex. Often associated with cervical abnormalities ( Premalignant and malignant disease of the lower genital tract).
• PMB: bleeding more than 1 year after cessation of periods. Exclude endometrial pathology or vaginal atrophy
• BEO: ‘bleeding of endometrial origin’, a diagnosis of exclusion, has replaced the term
‘dysfunctional uterine bleeding’ (DUB).

HMB is defined as ‘excessive menstrual blood loss which interferes with the woman’s physical, emotional, social and material quality of life, and which can occur alone or in combination with other symptoms’.
HMB is defined as a blood loss of greater than 80 ml per period.
Of women of reproductive age, 20–30% suffer from HMB
The NICE guidelines for HMB indicate the following investigations and are useful guide for clinicians:
• Full blood count (FBC) should be performed in all women (but serum ferritin should not be performed).
• Coagulation screen only if coagulation HMB since menarche or family history of coagulation defects.
• Hormone testing should not be performed.
• Pelvic ultrasound scan if history suggests structural or histological abnormality such as PCB, IMB,
pain/pressure symptoms, or enlarged uterus or vaginal mass is palpable on pelvic examination.
• High vaginal and endocervical swabs.
• EB should be considered if risk factors such as age over 45, treatment failure or risk factors for
endometrial pathology. Sensitivity of EB increases when performed in addition to using the cut-off of 4
mm endometrial thickness on TVUSS.
• Thyroid function tests should only be carried out when the history is suggestive of a thyroid disorder.
pain/pressure symptoms, or enlarged uterus or vaginal mass is palpable on pelvic examination.
• High vaginal and endocervical swabs.
• EB should be considered if risk factors such as age over 45, treatment failure or risk factors for
endometrial pathology. Sensitivity of EB increases when performed in addition to using the cut-off of 4
mm endometrial thickness on TVUSS.
• Thyroid function tests should only be carried out when the history is suggestive of a thyroid disorder.
pain/pressure symptoms, or enlarged uterus or vaginal mass is palpable on pelvic examination.
• High vaginal and endocervical swabs.
• EB should be considered if risk factors such as age over 45, treatment failure or risk factors for
endometrial pathology. Sensitivity of EB increases when performed in addition to using the cut-off of 4
mm endometrial thickness on TVUSS.
• Thyroid function tests should only be carried out when the history is suggestive of a thyroid disorder.
pain/pressure symptoms, or enlarged uterus or vaginal mass is palpable on pelvic examination.