How is it Diagnosed?
Abnormal Uterine Bleeding refers to any irregularity in the menstrual cycle—volume,
duration, or frequency—that is not caused by pregnancy. Diagnosis starts with a
comprehensive history, noting menstrual patterns, associated symptoms (pain,
discharge), medications, and reproductive history.
A physical examination, including pelvic examination, helps identify local causes such as
cervical lesions or uterine abnormalities. Pregnancy testing is essential in all
reproductive-age women to rule out pregnancy-related causes.
Hormonal evaluation includes thyroid function tests, prolactin levels, FSH, LH, and
estradiol to assess for endocrine disorders. CBC may be done to evaluate anemia due to
chronic blood loss.
Transvaginal ultrasound (TVUS) is the first-line imaging technique to evaluate uterine
and ovarian structures, including endometrial thickness and presence of fibroids or
polyps. In postmenopausal women, thickened endometrium may warrant further
investigation.
For endometrial assessment, endometrial biopsy is indicated in women over 35 or those
with risk factors for endometrial cancer. Saline infusion sonohysterography (SIS) and
hysteroscopy may provide more detailed assessment of intrauterine pathology.
The FIGO PALM-COEIN classification system is used to categorize AUB causes into
structural (Polyp, Adenomyosis, Leiomyoma, Malignancy) and non-structural
(Coagulopathy, Ovulatory dysfunction, Endometrial, Iatrogenic, Not yet classified)
categories.