Abnormal Uterine Bleeding

This chapter deals with abnormal uterine bleeding (AUB). It provides the background information of the disease, and discusses its prevention, diagnosis, treatment, prognosis, and evidence. Abnormal bleeding can refer to heavy menstrual bleeding, intermenstrual bleeding, and irregular bleeding. Most common etiologies of nonpregnant females are structural uterine pathology, anovulation, blood-clotting disorders, neoplasia, or medications. The physical examination includes an abdominal and pelvic examination as well as vital signs. Endometrial biopsy is performed in nonpregnant women aged greater than 45 with change in menstrual cycle or at any age with risk factors such as obesity, anovulation, or exposure to unopposed estrogen. Levonorgestrel-releasing intrauterine system (IUS) increases risk of pelvic infections. Women are tested for gonorrhea and chlamydia prior to placement of IUS and if culture is positive, the infection is treated with IUS in situ. First-line management for women with AUB are combined oral contraceptive pills.