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Management of abnormal uterine bleeding

Andrew M Kaunitz, MD
Section Editor
Robert L Barbieri, MD
Deputy Editor
Sandy J Falk, MD, FACOG


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 [1-3]. Chronic heavy or prolonged uterine bleeding can result in anemia, interfere with daily activities, and raise concerns about uterine cancer. AUB is a common reason for referral to a gynecologist, and 5 percent of women between the ages of 30 and 49 years consult a clinician for evaluation of menorrhagia [4-6]. Iron deficiency anemia develops in 21 to 67 percent of cases [7,8].

Most women with chronic AUB require medical attention but can be managed in an outpatient setting. Occasionally, an exacerbation of chronic AUB is severe enough to necessitate emergency medical care.

The management of chronic AUB in nonpregnant premenopausal women will be reviewed here. The general evaluation of AUB, acute uterine bleeding, bleeding during pregnancy, and postmenopausal bleeding are discussed separately. (See "Approach to abnormal uterine bleeding in nonpregnant reproductive-age women" and "Managing an episode of severe or prolonged uterine bleeding" and "Overview of the etiology and evaluation of vaginal bleeding in pregnant women" and "Postmenopausal uterine bleeding".)


A revised terminology system for AUB in nongravid reproductive-age women was introduced in 2011 by the International Federation of Gynecology and Obstetrics (FIGO) [9]. This was the result of an international consensus process with the goal of avoiding poorly defined or confusing terms used previously (eg, menorrhagia, menometrorrhagia, oligomenorrhea). The classification system is referred to by the acronym PALM-COEIN (polyp, adenomyosis, leiomyoma, malignancy and hyperplasia, coagulopathy, ovulatory dysfunction, endometrial, iatrogenic, and not yet classified) (figure 1). (See "Abnormal uterine bleeding in reproductive-age women: Terminology and PALM-COEIN etiology classification".)

In the PALM-COEIN system, the term heavy menstrual bleeding (HMB) refers to cyclic (ovulatory) menses that are heavy or prolonged [9]. It does not refer to heavy or prolonged bleeding that occurs in women with ovulatory dysfunction (AUB-O). The term HMB replaces the term menorrhagia, which was previously used to describe heavy or prolonged uterine bleeding. Menorrhagia is a less precise word because it does not differentiate between volume and duration of bleeding or between cyclic and anovulatory bleeding.

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Literature review current through: Oct 2017. | This topic last updated: Jun 07, 2017.
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