From the Guidelines
Ovulatory dysfunction is a primary nonstructural cause of abnormal uterine bleeding (AUB).
Causes of AUB
- Ovulatory dysfunction is a key contributor to AUB, characterized by irregularities in the menstrual cycle, including changes in frequency, volume, or duration of bleeding 1.
- Other nonstructural causes of AUB include coagulopathies, primary endometrial disorders, iatrogenic etiologies, and other causes not otherwise classified.
Diagnosis and Evaluation
- The workup of a woman with AUB begins with a thorough history and physical examination, followed by laboratory tests and potentially imaging to assess for structural abnormalities 1.
- Endometrial sampling may be considered in patients with AUB who have an increased risk for endometrial cancer or other structural abnormalities 1.
Clinical Considerations
- In premenopausal women, polyps, adenomyosis, and leiomyoma are common structural sources of AUB, while in postmenopausal women, endometrial cancer is a primary concern 1.
- A thorough evaluation and diagnosis are crucial to determine the underlying cause of AUB and guide appropriate management and treatment.
From the Research
Ovulatory Causes of Abnormal Uterine Bleeding (AUB)
The ovulatory causes of AUB can be attributed to various factors, including:
- Ovulatory dysfunction, which is a common cause of AUB in women of reproductive age 2
- Coagulopathy, which can lead to heavy menstrual bleeding (HMB) and is often caused by uterine fibroids or adenomyosis, a copper IUD, or coagulation disorders 2, 3
- Endometrial causes, such as endometrial polyps, which can cause AUB in approximately 68% of women 3
Classification of AUB
The PALM-COEIN classification system is used to define the underlying causes of AUB, which includes:
- PALM: Polyp, Adenomyosis, Leiomyoma, Malignancy, and hyperplasia
- COEIN: Coagulopathy, Ovulatory dysfunction, Endometrial, Iatrogenic, and Not yet classified 2, 3, 4
Diagnosis and Management of AUB
The diagnosis and management of AUB depend on the underlying cause, which can be determined through a combination of medical history, physical examination, and diagnostic tests 2, 4. Management options may include medical therapy, such as combination oral contraceptives, progestin-containing intrauterine devices, tranexamic acid, and nonsteroidal anti-inflammatory drugs, as well as surgical procedures for patients with structural lesions 4.