Abnormal Uterine Bleeding (AUB) refers to any deviation from the normal menstrual cycle in terms of frequency, duration, or volume of blood flow.
Etiology of AUB
1. Organic Causes
- Fibroid Uterus
- Adenomyosis
- Pelvic Endometriosis
- Chronic Tubo-Ovarian Mass
- Tubercular Endometritis
- Granulosa Cell Tumor of Ovary
2. Endocrine
Causes
- Hypothyroidism
- Polycystic Ovarian Syndrome (PCOS)
- Pituitary Disorders
3.
Hematological Causes
- Thrombocytopenic Purpura
- Leukemia
- Platelet Dysfunction Disorders
4. Functional
Causes
- Disturbed Hypothalamic-Pituitary-Ovarian
Axis
- Altered Endometrial Prostaglandins
Clinical
Features of AUB
- Heavy or prolonged
menstrual bleeding
- Irregular menstrual
cycles
- Intermenstrual
spotting
- Postmenopausal bleeding
Types
of Abnormal Uterine Bleeding
1. Menorrhagia
o Heavy and prolonged menstrual bleeding
o Causes:
Uterine
fibroids
Adenomyosis
Endometrial
hyperplasia
2. Metrorrhagia
o Irregular or intermenstrual bleeding
o Causes:
Endometrial
polyps
Endometrial
carcinoma
3. Polymenorrhea
o Frequent menstrual cycles (<21 days apart)
o Cause:
Luteal
phase defect
4. Oligomenorrhea
o Infrequent menstrual cycles (>35 days apart)
o Causes:
PCOS
Thyroid
dysfunction
5. Postmenopausal Bleeding
o Any vaginal bleeding occurring after menopause
o Causes:
Endometrial
carcinoma
Vaginal
atrophy
Investigations
for AUB
- Complete Blood Count
(CBC) – To detect anemia
- Hormonal Assays – Thyroid function
tests, FSH, LH, Prolactin
- Pelvic Ultrasound –
To detect fibroids, polyps
- Endometrial Biopsy –
To rule out malignancy
Management
& Treatment
1. Medical
Management
- NSAIDs (Mefenamic Acid, Ibuprofen) – For
pain relief
- Hormonal Therapy
- Oral
contraceptive pills
- Progesterone
therapy
- Gonadotropin-releasing
hormone (GnRH) analogues
- Iron Supplements – For anemia correction
2. Surgical
Management
- Dilation and Curettage (D&C) – For
endometrial sampling
- Endometrial Ablation – To reduce
bleeding
- Hysterectomy – In severe cases with
failed medical treatment
Keynote Symptoms of Abnormal Uterine
Bleeding (AUB)
- Heavy, prolonged, or
irregular menstrual bleeding
- Clots in menstrual
flow with cramping pain
- Weakness, dizziness,
and anemia due to blood loss
- Intermenstrual
spotting or postmenopausal bleeding
- Menstrual cycle
disturbances (frequent or delayed periods)
1. Sabina
Indications:
- Profuse, bright red bleeding with large
clots
- Excessive uterine bleeding, especially
in miscarriages or menopause
Keynote Symptoms:
- Pain extends from the lower back to the pubis.
- Bleeding worsens with the slightest motion.
- Uterine pain feels like it radiates from the
sacrum to the pubis.
- Miscarriage in the third month with profuse
bleeding.
- Worse from heat, motion, and exertion.
2.
Trillium Pendulum
Indications:
- Flooding type of bleeding, with
faintness and exhaustion
- Bleeding associated with fibroids or
menopause
Keynote Symptoms:
- Uterine hemorrhage with fainting and extreme
weakness.
- Sensation as if hips and back would fall apart.
- Bright red, gushing blood that stops and starts
again.
- Better by lying down and pressing the abdomen.
- Worse from the slightest motion.
3. Phosphorus
Indications:
- Frequent, prolonged, and painless
uterine bleeding
- Postmenopausal bleeding or
intermenstrual spotting
Keynote Symptoms:
- Bright red, excessive, and painless bleeding.
- Anemia, weakness, and desire for cold drinks.
- Bleeding tendency from gums, nose, and other
areas.
- Extreme thirst for cold water.
- Worse from lying on the left side.
4. Ferrum
Metallicum
Indications:
- Heavy menstrual bleeding with anemia and
paleness
- Weakness and easy exhaustion after
menstrual flow
Keynote Symptoms:
- Profuse, long-lasting periods with pale
complexion.
- Face alternates between being red and pale.
- Increased appetite despite weakness.
- Cold sensitivity and fatigue.
- Worse after exertion or walking.
5. Millefolium
Indications:
- Passive, painless uterine bleeding with
bright red blood
- Postpartum hemorrhage or bleeding after
an injury
Keynote Symptoms:
- Hemorrhage is profuse, bright red, and
painless.
- Nosebleeds accompany menstrual bleeding.
- Feels better in the open air.
- Bleeding due to overexertion or trauma.
- No clot formation in menstrual flow.
