1. Dr. Aya M. Serry Abnormal Uterine Bleeding (AUB) 2016
Pathophysiology
Dr. Aya M. Serry
Abnormal Uterine Bleeding
(AUB)
2016

2. Definitions Interval: 28 +/- 7 days (21-35 days)
Normal menstrual cycle
Interval: 28 +/- 7 days (21-35 days)
Can change from cycle to cycle
Length </= 7 days
Flow: Average blood loss: 35ml (20-60ml)
Menorrhagia
Prolonged – more than 7 days
or Heavy – greater than 80ml/day
Can be called “hypermenorrhea”

3. Definitions Polymenorrhea Bleeding occuring at intervals <21 days
Oligomenorrhea
Intervals between bleeding episodes vary from 35 days to 6 months
Amenorrhea
No menses for 6 months or more

4. Etiology of AUB Pregnancy
Hormonal Imbalance (hypothalamus /pituitary /ovary)
Hemostatic Disorders (systemic and local)
Reproductive Tract Pathology

5. Pregnancy Spontaneous/Incomplete Abortion
Gestational Trophoblastic Disease (a term used for a group of pregnancy-related tumors. These tumors are rare, and they appear when cells in the womb start to grow out of control)
“Normal Pregnancy”

6. Hormonal Hormonal Causes of AUB can be devided into :
A)ANOVULATORY AUB
B)OVULATORY AUB

7. Hormonal A) Anovulatory AUB (No Luteal Phase):
- The corpus luteum does not form in an anovulatory cycle, resulting in a failure of the cyclical secretion of progesterone
- Without progesterone, there is continuous unopposed production of estradiol, which stimulates overgrowth of the endometrium. (endometrial hyperplasia)
- The endometrium grows thick until it outgrows its blood supply, resulting in necrosis and irregular bleeding

8. Anovulation or Oligo-Ovulation
Pathophysiology
In a reproductive age patient who is not having regular menses, must determine if
1. Progesterone Deficient
2. Estrogen and Progesterone Deficient

9. Anovulation or Oligo-Ovulation
Patholophysiology
LACK OF PROGESTERONE
Estrogen production with lack of progesterone leads to unopposed estrogen stimulation of the endometrium
Can result in irregular shedding of the endometrium resulting in unscheduled/heavy bleeding
Potential for development of endometrial hyperplasia or cancer.

10. Anovulation or Oligo-Ovulation
Pathophysiology:
lack of ESTROGEN and PROGESTERONE
Lack of estrogen AND progesterone in reproductive age women can lead to osteoprorosis, increased risk for heart disease, and reduced quality of life
Examples: anorexia nervosa, athletic amenorrhea,

11. Hormonal B) Ovulatory AUB:
- Presents as menorrhagia (Abnormally heavy bleeding at menstruation)
- A less common cause of AUB; believed to be caused by a defect in local endometrial hemostasis
- The mechanism is unknown, but theories include hormonal imbalance and alterations in fibrinolysis.

12. Systemic Hemostatic Disorders
Inherited disorders
Example: Hemophilias (medical condition in which the ability of the blood to clot is severely reduced, causing the sufferer to bleed severely from even a slight injury)
Acquired disorders
Example: Liver Disease
Iatrogenic (drug induced )
Anticoagulants
NSAIDS

13. Reproductive Tract Disorders
Ovarian and Uterine Lesions
Poly Cystic Ovaries (PCOs)
Endometrial polyps
Endometritis
Hyperplasia or cancer

14. Diagnosis of AUB
Your doctor will ask you about your personal and family health history as well as your Menstrual Cycle
It may be helpful if you keep track of your menstrual cycle before your doctor visit (dates, length and type of bleeding)
You also may have blood tests (hormonal levels check). And a pregnancy test to check if you are pregnant

15. Diagnosis of AUB
Some other tests may be needed to diagnose AUB Including:
Sonohysterography:
Fluid is placed into the uterus via a thin tube while ultrasound images of the uterus are taken
Hysteroscopy:
Thin device is inserted through the vagina, allowing your doctor to see inside your uterus
Endometrial Biopsy

16. Treatment of AUB Medications: Birth control Pills Antibiotics
Hormonal medications
Birth control Pills
Antibiotics
Anti-inflammatory drugs

17. Treatment of AUB Surgeries:
D&C Surgery to remove abnormal uterine growths (Polyps)
Endometrial ablation
Hysterectomy (removal of the uterus)