From the Guidelines
Abnormal bleeding should be promptly evaluated and treated to prevent morbidity, mortality, and improve quality of life, with the most recent guidelines recommending a thorough history, physical examination, and appropriate laboratory tests, including imaging to assess for structural abnormalities 1. Abnormal bleeding refers to any unusual bleeding from the body, which can occur from various sites such as the vagina, rectum, urinary tract, or through vomiting or coughing up blood.
Causes and Diagnosis
The causes of abnormal uterine bleeding can be partitioned into structural and nonstructural etiologies, including endometrial polyps, adenomyosis, leiomyoma, malignancy, and coagulopathies, ovulatory dysfunction, and iatrogenic etiologies 1.
Treatment Options
For minor vaginal bleeding, medications like tranexamic acid or hormonal treatments such as combined oral contraceptives may be prescribed, while for gastrointestinal bleeding, proton pump inhibitors like omeprazole might be recommended 1.
Recent Guidelines
The most recent guidelines recommend endometrial ablation as a minimally invasive technique for patients with uterine fibroids associated with heavy menstrual bleeding who are refractory or intolerant to medical therapy, but only in patients who do not desire future pregnancy 1.
- Key points to consider:
- Abnormal bleeding can occur from various sites and has multiple causes
- Prompt evaluation and treatment are essential to prevent morbidity, mortality, and improve quality of life
- A thorough history, physical examination, and appropriate laboratory tests, including imaging, are necessary for proper diagnosis
- Treatment options vary depending on the underlying cause and severity of bleeding
- Recent guidelines recommend endometrial ablation for patients with uterine fibroids and heavy menstrual bleeding who do not desire future pregnancy 1
From the Research
Definition and Classification of Abnormal Bleeding
- Abnormal uterine bleeding refers to uterine bleeding that is abnormal in frequency, duration, volume, and/or regularity 2
- Etiologies of abnormal uterine bleeding can be classified using the PALM-COIEN system 2
- Abnormal bleeding can be caused by various factors, including bleeding disorders, medical conditions, and medications 3, 4, 5
Diagnosis and Evaluation of Abnormal Bleeding
- A thorough bleeding, medical, and family history is essential to determine the nature and severity of bleeding symptoms 3
- A comprehensive physical examination, including a pelvic examination, is necessary to identify any underlying causes of abnormal bleeding 2
- Laboratory investigations, such as a complete blood count (CBC) and coagulation studies, may be necessary to diagnose underlying bleeding disorders 4, 5
- The use of a Bleeding Assessment Tool can help clinicians obtain a comprehensive bleeding history and determine the individual bleeding score 3
Management and Treatment of Abnormal Bleeding
- Medical treatments for abnormal uterine bleeding include levonorgestrel intrauterine devices, oral contraceptive pills, and tranexamic acid 2
- Surgical treatment options for abnormal uterine bleeding include endometrial ablation and hysterectomy 2
- Management of bleeding disorders requires a thorough understanding of the underlying pathophysiologic processes and may involve consultation with a hematologist 4, 5
- Treatment of bleeding disorders depends on the specific disorder, bleeding phenotype, and anticipated risk of bleeding 4, 5