An adequate examination of the abdomen and the pelvis and uterine. Abnormal uterine bleeding aub is defined as changes in frequency of menses, duration of flow or amount of blood loss. It is a diagnosis of exclusion and is made only after. A common and often debilitating condition, affecting women of reproductive age. Aub is described by a variety of terms and may be caused by a number of genital and nongenital tract diseases, systemic disorders, and medications. Dysfunctional uterine bleeding is diagnosed when menstrual periods occur more frequently than normal within a cycle and all other probable organic and structural causes of such bleeding have been.
Dysfunctional uterine bleeding dub is a common cause of menstrual disturbances especially in teenage girls and women about to get menopause. Dysfunctional uterine bleeding describes the sp ectrum of abnormal bleeding patterns in the abscence of a medical illness or pelvic pathology. Pdf dysfunctional uterine bleeding and its management strategy. Michael evans developed the onepager concept to provide clinicians with useful clinical information on primary care topics. Although dysfunctional uterine bleeding, which is due to immaturity of the hypothalamicpituitaryovarian axis, may be the explanation for many of these issues, it is important to consider other. Abnormal uterine bleeding the menstrual bleed that is abnormally heavy or abnormal in timing assessment causes 1. Pdf management of dysfunctional uterine bleeding based on. Menorrhagia and uterine fibroids account for up to 75 percent of all hysterectomies performed worldwide. In ovulatory dysfunctional uterine bleeding, bleeding occurs cyclically, and menorrhagia is thought to originate from defects in the control mechanisms of menstruation. Abnormal uterine bleeding aub may be acute or chronic and is defined as bleeding from the uterine corpus that is abnormal in regularity, volume, frequency, or duration and occurs in the absence of pregnancy 1 2. Discussion dysfunctional uterine bleeding is defined as heavy menstrual uterine bleeding not due to. Guidelines for the management of abnormal uterine bleeding. Dysfunctional uterine bleeding dub is defined as abnormal uterine bleeding in the absence of organic disease.
Guidelines for the management of heavy menstrual bleeding. Dysfunctional uterine bleeding dub is a diagnosis of exclusion when there is no pelvic pathology or underlying medical cause. Clinical practice guidelines management of abnormal uterine. Treatment options for dysfunctional uterine bleeding. Dysfunctional uterine bleeding dub is irregular uterine bleeding that occurs in the absence of pathology or medical illness. Evaluation and management of abnormal uterine bleeding in premenopausal women. Abnormal uterine bleeding is a common problem,1 and its management can be complex.
It is very common in adolescents and is a clinical diagnosis. A new progestogenonly medical therapy for outpatient management of acute, abnormal uterine bleeding. Management of dysfunctional uterine bleeding springerlink. Abnormal uterine bleeding is one of the most common reasons for women to seek for care. In the meantime the article is available for download below. Abnormal uterine bleeding guidelines bmj best practice. Dysfunctional uterine bleeding, although not usually lifethreatening, can cause disruption and discomfort for many women. Abnormal uterine bleeding aub is a common and debilitating condition with high direct and indirect costs. Menstrual disorders and abnormal uterine bleeding aub are among the most frequent gynecologic complaints in adolescents. It may be associated with ovulatory and anovulatory cycles. Diagnosis and management of formerly called dysfunctional. Since this publication, some societies have released or revised their guidelines for the diagnosis and the management of the formerly called dysfunctional uterine bleeding according new figo classification. Dysfunctional uterine bleeding market research report.
Women with dysfunctional uterine bleeding dub are also very likely to suffer from mood swings. Abnormal uterine bleeding related to ovulatory dysfunction i. Being one of the common gynecological problems we did this study to find out the hospital prevalence, causes and management at chitwan medical college. Abnormal uterine bleeding aub page 4 of 6 disclaimer. The term dysfunctional uterine bleeding was used when no underlying cause was present. Abnormal dysfunctional uterine bleeding in emergency. Chronic abnormal uterine bleeding aub, a term that refers to menstrual bleeding of abnormal quantity, duration, or schedule, is a common gynecologic problem, occurring in approximately 10 to 35 percent of women. This algorithm has been developed for md anderson using a multidisciplinary approach considering circumstances particular to md anderson s specific patient population, services and structure. Adenomyosis, which is associated with abnormal uterine bleeding, pelvic pain. It is thought that, in women with ovulatory dysfunctional uterine bleeding, there is an increased rate of blood loss resulting from vasodilatation of the vessels supplying the. Several different therapies are available and individual women can choose from a number of options.
Abnormal uterine bleeding due to ovulatory dysfunction aubo is abnormal uterine bleeding that, after examination and ultrasonography, cannot be attributed to the usual causes structural gynecologic abnormalities, cancer, inflammation, systemic disorders, pregnancy, complications of pregnancy, use of oral contraceptives or certain drugs. National collaborating centre for womens and childrens health, national institute of clinical excellence. Dysfunctional uterine bleeding dub is a common debilitating problem amongst women in all age groups and accounts for 20% of gynecology office visits. It is responsible for about half of the women with abnormal uterine bleeding in reproductive age ewenstein, 1996. Dysfunctional uterine bleeding discharge care what you. Abnormal uterine bleeding aub, also known as atypical vaginal bleeding, is vaginal bleeding from the uterus that is abnormally frequent, lasts excessively long, is heavier than normal, or is irregular. Dysfunctional uterine bleeding pdf 59kb pdf back issue. Contributed by mr antonios v antoniou, consultant gynaecologist and lead in minimal access surgery and urogynaecology, newham university hospital and. Aub refers to bleeding that is excessive or occurs outside of normal cyclic menstruation.
We are currently working through back issues of afp for the afp website. Acog releases guidelines on management of abnormal uterine. Iucd related irregularity diagnosis is made by excluding organic cause. This can include alternating periods that are heavy and light, spotting or. Clinical policy effective11012011 19962012, oxford health plans, llc 3 manual endometrial ablation. Dysfunctional uterine bleeding dub is defined as abnormal uterine bleeding that results from an ovarian endocrinopathy. Abnormal uterine bleeding due to ovulatory dysfunction. Dysfunctional uterine bleeding describes the spectrum of abnormal bleeding.
Evaluation and management of adolescents with abnormal uterine bleeding. Dysfunctional uterine bleeding, with both anovulatory and, less commonly, ovulatory4 causes, occurs during the childbearing years. This article provides nps with a practical overview of the process from chief complaint to followup care. It usually presents as heavy menstrual bleeding menorrhagia. Evaluation and management of adolescents with abnormal. The guideline advisory committee gac database, the canadian medical association infobase for guidelines, and clinical evidence were also searched. What is the treatment for dysfunctional uterine bleeding. Dysfunctional uterine bleeding and uterine fibroids. Treatment of dysfunctional abnormal uterine bleeding. Most commonly, dub is associated with anovulatory menstrual cycles, systemic dysfunction, or medical conditions. Aub frequently coexists with fibroids, but the relationship between the two remains incompletely understood and in many women the identification of fibroids may be incidental to a.
Menarche occurs from 916 years with an average of 12. Perimenopausal dysfunctional uterine bleeding the perimenopause is the time prior to the natural cessation of menses when many changes occur due to the absence of ovulation and decreased estrogen production. Abnormal uterine bleeding aub is any variance of the normal menstrual cycle, which is defined on the basis of four parameters frequency, regularity, duration, and volume. It has often been poorly researched in the past, possibly because of the difficulty in measuring menstrual blood loss. Description dysfunctional uterine bleeding dub is a disorder that occurs most frequently in women at the beginning and end of their reproductive lives. The office management of dysfunctional uterine bleeding. To manage patients with dysfunctional uterine bleeding dub according to endometrial thickness.
Pdf dysfunctional uterine bleeding dub is a diagnosis of exclusion. Performing a vaginal hysterectomy be sure about the indication for vaginal hysterectomy. Abnormal uterine bleeding has various definitions and. Please take availability of treatment into consideration.
Management of acute abnormal uterine bleeding in nonpregnant. Approach to diagnosis and management of abnormal uterine bleeding. Health care practitioners deal with this problem frequently. The international federation of gynecology and obstetrics and the american congress of.
Dysfunctional uterine bleeding is prolonged, excessive or frequent, unpatterned uterine bleeding that is not related to an anatomical uterine abnormality or systemic cause. Management of dysfunctional uterine bleeding based on. Management of abnormal uterine bleeding in reproductive period. This includes procedures that use a resectoscope to surgically remove, electrically desiccate or vaporize the endometrium, as well as laser destruction of the. Definition dysfunctional uterine bleeding is irregular, abnormal uterine bleeding that is not caused by a tumor, infection, or pregnancy. The management of dysfunctional uterine bleeding glowm. Dysfunctional uterine bleeding background dysfunctional uterine bleeding dub is the major cause of heavy menstrual bleeding and impacts on womens health both medically and socially. Treatment of dysfunctional abnormal uterine bleeding 231 there is no evidence on what the best treatment is in acute severe menstrual bleeding. Abnormal uterine bleeding organic causes functional uterine bleedingdub deseases of genitaltract pregnancy related irregularity abnormal bleeding from genitaltract without any demonstrable organic cause. Dysfunctional uterine bleeding, also known as abnormal uterine bleeding, is irregular bleeding occurring in the absence of any recognizable pelvic pathology. It reflects a disruption in the normal cyclic pattern of ovulatory hormonal stimulation to the endometrial lining. Anovulatory dysfunctional uterine bleeding may therefore occur and results in irregular. This guideline provides recommendations to gynaecologists and other health care providers in the diagnosis and management of abnormal uterine bleeding, incorporating the current evidence.
Dysfunctional uterine bleeding occurs when the cycles hormonal signals get thrown off. Abnormal uterine bleeding aub is a condition that affects approximately 30% of women during their reproductive years. Pdf to manage patients with dysfunctional uterine bleeding dub according to endometrial thickness. Dysfunctional uterine bleeding dub is defined as abnormal bleeding in the absence of intracavitary or uterine pathology. Most of the time, if periods arent regular its because a girls body is still developing. The recommendations in this guideline represent the view of nice, arrived at after careful. The diagnosis and treatment of dysfunctional uterine bleeding can be a long emotional journey for the patient and a difficult challenge for the provider. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Ovulatory dysfunctional uterine bleeding is the major pattern in 30s, whereas anovulatory dysfunctional uterine bleeding is more likely to occur at the extremes of reproductive years and in women who have polycystic ovarian syndrome. The diagnosis of dub can only be made once all other causes of abnormal or heavy uterine bleeding have been excluded.
The diagnosis of dub depends on a thorough history and physical examination to exclude organic disorders. Its prevalence, causes and management in chitwan abstract abnormal uterine bleeding is a common morbid condition of woman seeking medical advice. Pdf management of dysfunctional uterine bleeding based. Chronic abnormal uterine bleeding aub, a term that refers to menstrual bleeding of abnormal quantity, duration, or schedule, is a common. Dysfunctional uterine bleeding by, nazni nazar 2009 mbbs 2. Chronic heavy or prolonged uterine bleeding can result in anemia, interfere with daily activities, and raise concerns about uterine cancer. Highdose medroxyprogesterone acetate for the treatment of dysfunctional uterine bleeding in 24 adolescents. You may have bleeding from your uterus at times other than your normal monthly period. Abnormal uterine bleeding occurs in 9 to 14 percent of women between menarche and menopause, significantly impacting quality of life and imposing financial burden. Dysfunctional uterine bleeding dub it can take a while for a girls menstrual cycle to settle into something regular. Acute aub refers to an episode of heavy bleeding that, in the opinion of the clinician, is of sufficient quantity to require immediate intervention to prevent further blood loss 1. Abnormal uterine bleeding is a broad term that indicates a change in frequency of menses, duration of flow or amount of blood loss. Dub is typically characterized by heavy prolonged flow with or without breakthrough bleeding. Dysfunctional uterine bleeding dub is abnormal uterine bleeding that is caused by a problem with your hormones.
Abnormal uterine bleeding between menarche and menopause figure 2. Abnormal uterine bleeding aub is a common but complicated clinical presentation. Clinical practice clinical update dysfunctional uterine. Evaluation and management of abnormal uterine bleeding in.