What is AUB?
Abnormal Uterine Bleeding (AUB) is any deviation from the normal menstrual cycle in terms of frequency, regularity, duration, or volume. It’s a common complaint affecting women across all reproductive ages and significantly impacts quality of life.
The International Federation of Gynecology and Obstetrics (FIGO) developed the PALM-COEIN classification system to help clinicians categorize causes of AUB:
PALM (structural causes):
- Polyp
- Adenomyosis
- Leiomyoma
- Malignancy and hyperplasia
COEIN (non-structural causes):
- Coagulopathy
- Ovulatory dysfunction
- Endometrial disorders
- Iatrogenic
- Not yet classified
What is DUB?
Dysfunctional Uterine Bleeding (DUB) refers specifically to AUB in the absence of any structural or systemic pathology. It’s often due to hormonal imbalances, particularly affecting ovulation. DUB is a diagnosis of exclusion, primarily affecting adolescents and women approaching menopause.
Symptoms to Watch For
- Heavy or prolonged periods
- Irregular menstrual cycles
- Bleeding between periods
- Menstrual cycles shorter than 21 or longer than 35 days
- Postmenopausal bleeding
- When these symptoms are persistent, medical evaluation is essential.
Causes of AUB and DUB
- Hormonal imbalances (e.g., PCOS, thyroid disorders)
- Fibroids and polyps
- Endometrial hyperplasia
- Coagulopathies like von Willebrand disease
- Certain medications (e.g., anticoagulants, hormonal therapies)
Diagnosis
- Evaluation includes:
- Detailed menstrual and medical history
- Pelvic examination
- Blood tests (CBC, TSH, FSH, coagulation profile)
- Pelvic ultrasound
- Endometrial biopsy (especially in women over 35 or with risk factors for endometrial cancer)
- Hysteroscopy (for visualizing intrauterine pathology)
Management of AUB (Based on FOGSI Guidelines)
The Federation of Obstetric and Gynaecological Societies of India (FOGSI) outlines a tiered approach to management:
1. Medical Management
Hormonal therapies:
Combined oral contraceptives (COCs) to regulate cycles
Progestins (cyclic or continuous)
Levonorgestrel-releasing intrauterine system (LNG-IUS)
Non-hormonal options:
Tranexamic acid (antifibrinolytic)
NSAIDs (e.g., mefenamic acid) to reduce menstrual flow and pain
GnRH analogues: Used short-term for fibroid-related AUB
2. Surgical Management
Indicated when medical therapy fails or structural lesions are present.
Minimally invasive techniques:
- Polypectomy
- Myomectomy
- Endometrial ablation
Definitive surgery:
Hysterectomy, reserved for women with refractory symptoms or malignancy risk
Mechanical Hysteroscopic Tissue Removal (mHTR) is a fertility-preserving, anesthesia-free option for polyp or fibroid removal.
Lifestyle and Supportive Measures
- Weight loss and stress management can help in cases like PCOS-induced AUB
- Iron supplementation for chronic blood loss
- Psychological support for anxiety and stress due to bleeding disorders
Final Thoughts
AUB and DUB are treatable with timely diagnosis and individualized management. With structured guidelines like those from FOGSI, healthcare providers can offer evidence-based solutions that preserve fertility and improve quality of life.
If you’re experiencing abnormal menstrual symptoms, don’t ignore them. Early intervention leads to better outcomes. For personalized advice, consult a gynecologist or visit a women’s health center near you.