Summary of "Abnormal Uterine Bleeding (AUB) - Menorrhagia & Heavy Menstrual Bleeding | (Including Mnemonic!)"

Summary of “Abnormal Uterine Bleeding (AUB) - Menorrhagia & Heavy Menstrual Bleeding | (Including Mnemonic!)”

Main Ideas and Concepts

Definition of Abnormal Uterine Bleeding (AUB)

Abnormal uterine bleeding is vaginal bleeding from the uterus that deviates from normal menstruation in terms of frequency, duration, volume, or regularity. Normal menstrual parameters include:

Frequency: 24–38 days
Duration: ≤ 8 days
Blood loss: < 80 mL
Cycle variation: < 4 days

Bleeding occurring beyond 6 months post-menopause is abnormal and may indicate endometrial cancer.

Epidemiology

Approximately 30% of women of reproductive age experience AUB.

Causes of AUB (PALM-COEIN Mnemonic)

A widely used classification system to remember causes of AUB:

P: Polyps
- Endometrial or endocervical polyps, often asymptomatic but can cause bleeding.
- Endometrial polyps have a prevalence of about 15%.
A: Adenomyosis
- Presence of endometrial tissue within the myometrium (muscular uterine layer).
- Leads to prolonged and heavier periods.
L: Leiomyomata (Fibroids)
- Benign smooth muscle tumors of the uterus, very common (80% by age 50).
- Most are asymptomatic; heavy menstrual bleeding is the most common symptom when symptomatic.
M: Malignancy and Hyperplasia
- Includes cervical cancer, endometrial cancer, and atypical hyperplasia.
- Risk factors: unopposed estrogen, early menarche, nulliparity, anovulation, tamoxifen therapy.
C: Coagulopathy
- Bleeding disorders like von Willebrand’s disease causing more severe bleeding.
O: Ovulatory Dysfunction
- Disruption in normal ovulation and progesterone production.
- Causes include PCOS, anorexia, excessive exercise, hyperprolactinemia.
E: Endometrial Dysfunction
- Diagnosis of exclusion when no structural or systemic cause is found.
I: Iatrogenic
- Medication-induced bleeding (e.g., anticoagulants, inconsistent hormonal contraception).
N: Not Otherwise Classified
- Miscellaneous causes like arteriovenous malformations and endometritis.

Clinical History and Symptoms

Assess frequency, duration, volume (e.g., changing pads/tampons hourly), and regularity of bleeding.
Associated symptoms may include:
- Urinary frequency/urgency, constipation, low back pain (suggest fibroids)
- Hirsutism (suggests PCOS)
- Galactorrhea (suggests hyperprolactinemia)
Heavy bleeding since menarche suggests coagulopathy.

Investigations

Blood tests: full blood count, pregnancy test, coagulation profile, prolactin, LH, FSH (especially if PCOS suspected).
Imaging: ultrasound (transvaginal preferred for pelvic evaluation), MRI.
Endometrial biopsy: recommended for women >45 years, or younger women with risk factors (unopposed estrogen, persistent bleeding, obesity, PCOS, tamoxifen use).
Hysteroscopy: endoscopic visualization of the uterus, useful for suspected fibroids or polyps.

Complications

Risk of hypovolemia and shock in severe bleeding.
Chronic blood loss can lead to iron deficiency anemia.

Management

Acute Severe Bleeding

Apply pressure (e.g., Foley catheter) to control bleeding.
Fluid resuscitation and tranexamic acid (anti-fibrinolytic).
Blood transfusion and cross-matching if needed.
Exploratory surgery in refractory cases.

Chronic AUB (>6 months)

Hormonal therapy: combined oral contraceptives, GnRH agonists.
Tranexamic acid and NSAIDs to reduce bleeding.
Iron supplementation for anemia.
Surgical options: hysterectomy, endometrial ablation, polyp removal.

Detailed Methodology for Evaluation and Management of AUB

History Taking
- Document menstrual frequency, duration, volume, and regularity.
- Ask about symptoms suggestive of underlying causes (e.g., hirsutism, galactorrhea).
- Note any history of heavy bleeding since menarche or medication use.
Physical Examination
- Look for signs of anemia or systemic disease.
- Perform pelvic examination to identify masses or lesions.
Laboratory Tests
- Full blood count to assess anemia.
- Pregnancy test to exclude pregnancy-related bleeding.
- Coagulation profile if bleeding disorder suspected.
- Hormone levels (prolactin, LH, FSH) if indicated.
Imaging
- Perform pelvic ultrasound (prefer transvaginal).
- MRI if further characterization needed.
Endometrial Sampling
- Biopsy in women >45 years or with risk factors.
Additional Procedures
- Hysteroscopy for direct visualization and possible treatment of intrauterine lesions.
Acute Management
- Control bleeding with mechanical pressure (Foley catheter).
- Administer tranexamic acid and fluids.
- Transfuse blood if necessary.
- Consider surgery if bleeding persists.
Long-term Management
- Hormonal therapies (oral contraceptives, GnRH agonists).
- Tranexamic acid and NSAIDs for symptom control.
- Iron supplementation for anemia.
- Surgical options for refractory or structural causes.

Speakers and Sources Featured

The video appears to be presented by a single medical educator or narrator.
Content references guidelines such as those from NICE (National Institute for Health and Care Excellence) for biopsy recommendations.

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Summary of "Abnormal Uterine Bleeding (AUB) - Menorrhagia & Heavy Menstrual Bleeding | (Including Mnemonic!)"