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Abnormal uterine bleeding in the premenopausal period

Abnormal uterine bleeding (AUB) is a very frequent symptom in women. The prevalence of AUB is estimated at 12% in the general population and increases with age, reaching 24% in those aged 36–40 years. When it is a single episode of irregular blood loss in non-pregnant women, it is most of the time harmless, but it can also be a first sign of serious pathology such as cancer of the cervix. | 9 Abnormal Uterine Bleeding in the Premenopausal Period Heleen van Beekhuizen INTRODUCTION Abnormal uterine bleeding AUB is a very frequent symptom in women. The prevalence of AUB is estimated at 12 in the general population and increases with age reaching 24 in those aged 36-40 years. When it is a single episode of irregular blood loss in non-pregnant women it is most of the time harmless but it can also be a first sign of serious pathology such as cancer of the cervix. For this reason it is important to do a full gynecological history a speculum examination and a vaginal examination in all women with AUB. For practical purposes it is important to rule out unrecognized pregnancy problems or infection in AUB of short duration. A longer duration of AUB points to more structural abnormalities like fibroids polyps or malignancies. This chapter will describe the problems and how to establish the diagnosis. A flow chart for abnormal uterine bleeding will be introduced. In Chapter 20 appropriate treatment of abnormal uterine bleeding will be explained. For bleeding after the menopause please see Chapter 10. Definition Terms like menorrhagia metrorrhagia meno-metrorrhagia should be abolished as their definitions differ from region to region. It is better to speak of abnormal uterine bleeding A normal cycle is between 24 and 35 days with a period of 7 days. The main menstrual blood flow during a period is 35 ml with 65 of women losing 60 ml each period. Menorrhagia regular cycle but blood loss 80 ml per cycle1. Metrorrhagia bleeding at irregular intervals. Intermenstrual blood loss IBL irregular blood loss during a normal menstrual cycle. Chronic abnormal uterine bleeding Chronic AUB is defined by the International Federation of Gynecology and Obstetrics FIGO as bleeding from the uterine corpus that is abnormal in volume regularity and or timing and has been present for the majority of the past 6 months in non-pregnant women. Acute abnormal uterine bleeding Acute AUB is .