Abnormal uterine bleeding causes

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rinky Agnes Botleroo, M.B.B.S., Arooj Naz, M.B.B.S

Uterine bleeding can be divided into anatomical or structural and non-structural causes. The anatomical causes include Polyp, adenomyosis, Leiomyoma and Malignancy or hyperplasia. The non-structural causes include Coagulopathy, Ovulatory dysfunction, such as PCOS, Endometrial disorders, such as endometriosis, and Iatrogenic causes. In some women, no underlying cause can be identifiedd. These women are thought to have abnormal bleeding due to causes not otherwise classified.

Dysfunctional uterine bleeding (DUB) is a historical term for a diagnosis of exclusion, referring to abnormal uterine bleeding unrelated to structural uterine abnormalities.

Other conditions such as uterine fibroids, endometrial polyps and systemic diseases should be excluded by appropriate investigations. In the adolescent, investigations for a coagulopathy should be performed. The pathophysiology of DUB is largely unknown but occurs in both ovulatory and anovulatory menstrual cycles.

PALM-COEIN is a useful acronym provided by the International Federation of Obstetrics and Gynecology (FIGO) to classify the casuses of abnormal uterine bleeding. The first portion, PALM, describes anatomical issues. The second portion, COEI, describes non-structural causes. The N stands for “not otherwise classified.”^[1]

P: Polyp

Endometrial polyps refer to overgrown glands and storm within the uterine cavity. The vary in size, number and location and are most common amongst the ages of 40-49.^[2]

A: Adenomyosis

Adenomyosis is characterized by the presence of ectopic endometrial tissue (the inner lining of the uterus) within the myometrium (the thick, muscular layer of the uterus). It is most commonly seen affects most women in their 30’s and 40’s.^[3]

L: Leiomyoma

Leiomyoma are tumours of benign origin made up primarily of smooth muscle and fibrous connective tissue that can presents as serosal, submucosal, subserosalor pedunculated masses. They most often affect women over the age of 50, and especially those of African descent.^[4]

M: Malignancy and hyperplasia

Endometrial malignancy is a common cause of post-menopausal bleeding and often has a higher mortality rate. Women between the ages of 65-74 are most often affected.^[5]

C: Coagulopathy

Coaguloptahies refer to any conditions, inherited or acquired that result in abnormal uterine bleeding.

O: Ovulatory dysfunction

A very common ovulatory dysfunction resulting in abnormal uterine bleeding is polycystic ovarian syndrome. This most often presents in young women due to a hormonal imbalance.

E: Endometrial disorders

Endometrial disorders, such as endometriosis can result in abnormal bleeding. Endometriosis is the presence of functional endometrial tissue outside the uterine cavity. When proliferating and shedding, endometrial tissue in all various locations will act similarly.

I: Iatrogenic

Iatrogenic causes of abnormal bleeding include unopposed and continuous exposure to estrogen and progesterone therapy, as is seen with contraceptive medications, GnRH agonists, and SERMs.^[6] Anticoagulant medications are also included in this category now.

N: Not otherwise classified

This category is reserved for those in whom no other underlying cause can be diagnosed despite examinations and imaging.

• Dysfunctional uterine bleeding
• Leiomyomas (fibroids)
• Endometrial hyperplasia
• Abortion
• Cervicitis
• Endometrial Carcinoma
• Endometritis
• Pelvic Inflammatory Disease
• Vaginitis

Template:WH Template:WS