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TERMINOLOGIES AND CLASSIFICATION Coagulopathy (AUB-C)

Polyps (AUB-P) o Encompasses the spectrum of Systemic Disorders


o Polyps in the endometrium that are diagnosed by of Hemostasis, 13% prevalence rate of the
ultrasound or hysteroscopy. biochemical markers of von Willebrand Disease
o Associated with Tamoxifen. among women with HMB.
o Increased risk of Malignant/Pre-Malignant Change in o Women on chronic Anti-Coagulant Drugs (Warfarin,
postmenopausal women. Heparin, Low Molecular Weight Heparin)
o Recognized structural abnormalities causing AUB. o Coagulopathy, which in most cases is diagnosed in
o Found in all age groups, but mostly in older women. adolescents.
o Present as heavy menstrual, intermenstrual, or o von Willebrand Disease
post-menstrual bleeding associated with Most common inherited blooding disorder
Dysmenorrhea. Incidence: 1:100 1:1000
o AUB-P1 Present Quantitative Defects: Type 1 & Type 3
o AUB-P0 Absent Qualitative Defects: Type 2
Adenomyosis (AUB-A) Easy bruising & mucocutaneous bleeding
o Adenomyosis which can be most accurately Defective primary hemostasis
diagnosed on the basis of tissue analysis of a Decreased adherence to vascular
hysterectomy specimen, but MRI and Ultrasound injury
are used to established the diagnosis. Inadequate platelet plus prolongs
o Hypotheses: bleeding time
Increased Endometrial Surface o vWD: Diagnosis
Altered PGE/PGF2 Normal Platelet Count (except Type 2B)
Hampered Myometrial Contractility Low to Normal Factor VIII Activity (10-40%)
Abnormal Myometrial Angiogenesis vWF Antigen
associated with Fragile Blood Vessels vWF Activity (Rotacetin Co-Factor Activity)
o AUB-A1 Prolonged Bleeding Time
Leiomyoma (AUB-L) Normal Coagulation Time (aPTT, PT)
o Leiomyomas, solitary or multiple, can be located Rotacetin Induced Platelet Aggregation
close to the cavity (Submucosal), in the RIPA (+) in Type 2B (negative in other
myometrium (Subserosal), or independent of the types)
uterus (Parasitic). Ovulatory Dysfunction (AUB-O)
SUBMUCOSAL most likely to cause o Ovulatory dysfunction, in which cycle length and
bleeding volume of flow are unpredictable.
o Heavy Menstrual Bleeding may cause Anemia. o Usually manifests as a combination of
o Myoma-related AUB may result from: unpredictable bleeding & variable amount of flow.
Increased Endometrial Surface Area due to o Most common after Menarche (Immature HPO Axis)
Mechanical Distortion. or just before Menopause (decline in Inhibin & rise
Ulceration & Hemorrhage of Endometrium in FSH result in disturbed Ovulations) but may
overlying the Submucous Fibroids. occur in other times.
Interference by the Myomas with normal o Exact etiology is unknown but some may be due to
Uterine Hemostasis. Endocrinopathies:
Mechanical compression of the Venous PCOS
Drainage by the Myomas at any site. Hypothyroidism
Dilation of the Venous Plexuses draining the Hyperprolactinemia
Endometrium. Mental Stress
o Primary Classification: Reflects the presence (AUB- Obesity
L1) or absence (AUB-L0) of the Leiomyoma, Anorexia
regardless of the location, number, & size, Weight Loss
confirmed on Ultrasound Examination. Extreme Exercise
o Secondary Classification: Differentiates
Endometrial Dysfunction (AUB-E)
Leiomyomas involving the Endometrial Cavity.
o Endometrial problems, typically related to abnormal
SM Submucosal
prostaglandin synthesis, but which could be the
O Others
result of infection as well.
Iatrogenic (AUB-I)
SM 0 Pedunculated Intracavitary
o Iatrogenic causes, which are typically the result of
(Submucos 1 < 50% Intramural
al) exogenous hormone administration or
2 50% Intramural
anticoagulant therapy.
3 Contacts Endometrium (100% o Contraceptive Hormones, IUD, Steroids,
Intramural)
Tranquilizers, Digitalis, Dilantin, Rifampicin, &
O 4 Intramural Griseofulvin
(Others) 5 Subserosal 50% Intramural Non-Classified (AUB-N)
6 Subserosal < 50% Intramural o Non-classified causes such as arteriovenous
7 Subserosal Pedunculated malformations and myometrial hypertrophy
8 Others (e.g. Cervical, Parasitic,
etc.)

Malignancy (AUB-M)
o Malignancyc, inducing hyperplasia and endometrial
cancer. The diagnosis requires the histologic
analysis of a biopsy sample