From the Guidelines
Abnormal uterine bleeding (AUB) is classified as acute or chronic based on severity and duration, with acute AUB requiring immediate intervention due to hemodynamic instability or significant anemia, and chronic AUB defined as bleeding that has been abnormal in volume, regularity, or timing for at least 3 months. The difference between acute and chronic AUB lies in their management approaches, with acute AUB focusing on hemodynamic stabilization and chronic AUB depending on the underlying cause identified using the PALM-COEIN classification system 1. Key factors to consider in differentiating between acute and chronic AUB include:
- Severity of bleeding
- Duration of bleeding
- Presence of hemodynamic instability or significant anemia
- Underlying cause of bleeding, as classified by the PALM-COEIN system, which includes structural causes (polyp, adenomyosis, leiomyoma, and malignancy and hyperplasia) and nonstructural causes (coagulopathy, ovulatory dysfunction, endometrial, iatrogenic, and not yet classified) 1. For chronic AUB, treatment options may include hormonal treatments like combined oral contraceptives or progestins, or non-hormonal options like tranexamic acid or NSAIDs, aiming to stabilize the endometrium, reduce prostaglandin production, or enhance clotting mechanisms to control bleeding patterns 1. In cases where medical treatment fails, is contraindicated, or is not tolerated, or if the patient has concomitant significant intracavitary lesions, surgery, including endometrial ablation and hysterectomy, may be considered as an option for chronic AUB management 1.
From the Research
Definition and Classification of Abnormal Uterine Bleeding (AUB)
- Abnormal uterine bleeding (AUB) is a common complaint that affects large numbers of women from puberty to menopause 2.
- AUB can be classified into two main categories: acute and chronic abnormal uterine bleeding.
Acute Abnormal Uterine Bleeding
- Acute abnormal uterine bleeding is characterized by heavy or prolonged bleeding that requires immediate medical attention 3, 4.
- The initial evaluation of a patient with acute AUB should include a prompt assessment for signs of hypovolemia and potential hemodynamic instability 3.
- Medical management is the first-line approach for treating acute AUB, with options including intravenous conjugated equine estrogen, multi-dose regimens of combined oral contraceptives or oral progestins, and tranexamic acid 3, 5.
Chronic Abnormal Uterine Bleeding
- Chronic abnormal uterine bleeding refers to repetitive bleeding problems that are not acute in nature 4.
- The management of chronic AUB depends on the underlying cause and may involve medical or surgical treatment options 4, 2.
- Medical treatment for chronic AUB may include hormonal and non-hormonal therapies, such as oral contraceptives, progestins, and tranexamic acid 5, 2.
- Surgical treatment options for chronic AUB may include removal of a focal lesion, endometrial resection or destruction, and hysterectomy 2.
Key Factors in Managing AUB
- Age, desire for future pregnancy, and etiology of AUB are key factors to consider when initiating treatment 2.
- Treatment efficiency can be assessed using the same tools as pretherapeutic evaluation, and improvement of quality of life has now become the main goal for most international guidelines addressing the subject 2.