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Heavy%20menstrual%20bleeding Signs and Symptoms
Introduction
- Common problem in women of reproductive age (increases with age) which usually causes anemia
- Most common symptom experienced by women with bleeding disorder
Definition
- Prolonged (>7 days) or excessive (>80 mL) uterine bleeding occurring at regular intervals over several menstrual cycles
- Menstrual blood loss that is excessive and interferes with patient’s physical, emotional, social and quality of life
Etiology
- Causes of abnormal uterine bleeding (AUB) are categorized into the following groups:
- Discrete structural abnormalities that can be examined with imaging techniques and/or histopathology
- PALM: Polyp, adenomyosis, leiomyoma, malignancy and hyperplasia
- Please see Leiomyomas disease management chart for further information
- Non-structural abnormalities that cannot be defined by imaging or histopathology
- COEIN: Coagulopathy, ovulatory dysfunction, endometrial, iatrogenic, not otherwise classified
- Coagulopathy includes von Willebrand’s disease (VWD) or platelet dysfunction
- Iatrogenic causes include AUB associated with use of hormonal or non-hormonal medications (eg anticoagulation therapy), intrauterine systems or devices, or other local or systemic agents
- Not otherwise classified causes include conditions that are rare or ill-defined that do not fit into any classification
- Other causes include chronic endometrial infection, arteriovenous malformation, hypothyroidism, obesity
- Patients may have >1 cause
- Discrete structural abnormalities that can be examined with imaging techniques and/or histopathology
- Anovulation is the most common cause in adolescents and perimenopausal women; structural lesions and malignancy are more common with increasing age
