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ABNORMAL UTERINE
BLEEDING

Introduction
Abnormal uterine bleeding (AUB) is defined as bleeding
from the uteruine corpus that is abnormal in volume,
regularity, and/or timing.
AUB afffect about 5-10% woman of reproductive age and
probably higher percentage of women in older age groups.
There has not been clarity with the diagnosis for women
who present with deviation in uterine bleeding.
Cumbersome terminology and confusing research
outcome measures have bought forth recommendation
from the FIGO for a universal classificaation system to
describe AUB abnormalities in reproductive women.
The PALM-COEIN classification identifies uterine bleeding
abnormalities.
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Menstrual cycle

The PALM-COEIN Classification


system for causes of AUB

PALM Visually objective structural


criteria
COEI unrelated to structural
anomalies
N Entities not yet classified

POLYPS (AUB-P)
Abnormal vaginal
bleeding is the most
common presenting
symptom in polyps.
Polyps are
categorized as either
present or absent.
Diagnosed by TVUS,
saline infusion
sonography, and
hysteroscopy.
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ADENOMYOSIS (AUB-A)
The criteria for diagnosing
adenomyosis determined
by the depth of
endometrial tissue
beneath the endometrialmyometrial interface from
hysterectomy specimens.
70% of women with
adenomyosis have
symptoms of AUB. 30%
have dysmenorrhea. 19%
have both. Diagnosed by
ultrasound or MRI.
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LEIOMYOMAS (AUB-Lsm or AUB-Lo)

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MALIGNANCY (AUB-M)
AUB is primary
symptom of
endometrial
neoplasia
AUB-M include
both premalignant
and malignant
lesion.
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COAGULOPATHY (SYSTEMIC
DISORDER OF HEMOSTASIS) (AUB-C)
The term coagulopathy
is used to encompass
the spectrum of
systemic disorder of
hemostasis that may
caused AUB.
About 13% women with
HMBhave biochemically
detectable systemic
disorders of hemostasis,
most often von
willebrand diseases.
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OVULATORY DISORDER
(AUB-O)
Ovulatory disorder
is one of the
leading cause of
AUB, manifesting
in some
combination of
unpredictable
timing of bleeding
and variable
amount of flow.
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ENDOMETRIAL CAUSES
(AUB-E)
Most patients in this
category will have regular
cycles, normal ovulation
and no definable cause of
AUB. Usually present with
HMB, Which may indicate
a disorder of endometrial
hemostasis. Others may
present with IMB, which
may be secondary to
inflammation, infection,
or abnormal
inflammatory responses.
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IATROGENIC (AUB-I)
Can be caused by medical
interventions or device.
Unscheduled endometrial bleeding
that occurs during the use of
exogenous gonadal steroid therapy is
termed breakthrough bleeding (BTB)
happend because low consentration
estrogent in circulation can be caused
by
Patient forgot or late in consuming
contraseption pill
Daily usage of medication such as
rifampisin

Causes include IUD, exogenous gonald


steroid and other systemic agents
that affect blood coagulation or
ovulation. Bleeding from
anticoagulation therapy is listed under
AUB-C rather than AUB-I
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NOT YET CLASSIFIED (AUBN)


Reserved for entities that are poorly
defined and/or not well examined.

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NOTATION

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References
1. Hoffman B,Schorge j, et all. Menstrual Cycle: William
Gynecology second edition. Dallas Parkland Hospital: Mc
Graw Hill Professional; 2012.
2. Munro MG, Critchley HOD, Fraser IS. The FIGO classification
of causes of abnormal uterine bleeding in the reproductive
years: Fertility and sterility. American Society for
Reproductive Medicine 2011;95(7): 2204-2208.
3. Qureshi FU, Yusuf AW. Disstribution of causes of abnormal
uterine bleeding using the new FIGO classification system:
Departement of Obstetrics and Gynaecology 2013;63(8):
973-975.
4. Twiss JJ. A new look at abnormal uterine bleeding: the nurse
practitioner. Lippincott William & Wilkins 2013;38(12): 2230.
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