Dysmenorrhea is NOT Abnormal Uterine Bleeding
No, dysmenorrhea (painful menstrual cramps) does not fall within the diagnosis of abnormal uterine bleeding (AUB). These are distinct clinical entities that may coexist but represent different pathological processes.
Key Distinctions
- AUB is defined as uterine bleeding that varies from normal parameters of menstruation in regularity, volume, frequency, or duration 1, 2
- Dysmenorrhea is menstrual pain, not a bleeding disorder 3, 4
- The PALM-COEIN classification system used to categorize AUB causes does not include dysmenorrhea as a component 5, 6
When Dysmenorrhea Suggests Secondary Pathology
While dysmenorrhea itself is not AUB, certain presentations warrant investigation for conditions that cause BOTH symptoms:
- Adenomyosis frequently presents with both heavy menstrual bleeding AND dysmenorrhea, along with dyspareunia, commonly affecting women in their 40s 5
- Secondary dysmenorrhea with abnormal uterine bleeding, progressive worsening pain, vaginal discharge, or dyspareunia suggests underlying pelvic pathology such as endometriosis, anatomic abnormalities, or infection 3, 4
- Endometriosis is the most common cause of secondary dysmenorrhea and may present with concurrent bleeding abnormalities 4
Clinical Implications
- Primary dysmenorrhea (menstrual pain without pelvic pathology) occurs in 50-90% of reproductive-age women and is managed independently from AUB 3
- If a patient presents with dysmenorrhea alone without changes in bleeding pattern, volume, frequency, or duration, this does not constitute AUB 1, 2
- When both dysmenorrhea and abnormal bleeding patterns coexist, transvaginal ultrasonography should be performed to evaluate for structural causes 4
Common Pitfall to Avoid
Do not conflate pain with bleeding disorders. A patient with severe dysmenorrhea but normal menstrual bleeding patterns does not have AUB and should be evaluated and treated according to dysmenorrhea protocols (NSAIDs, hormonal contraceptives) rather than AUB algorithms 3, 4.