Abnormal (Dysfunctional) Uterine Bleeding Clinical Presentation

Updated: Mar 29, 2022
  • Author: Thomas Michael Price, MD; Chief Editor: Richard Scott Lucidi, MD, FACOG  more...
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Presentation

History

Suspect abnormal uterine bleeding (AUB) when a patient presents with unpredictable or episodic heavy or light bleeding despite a normal pelvic examination.

Note the following:

  • Typically, the usual moliminal symptoms that accompany ovulatory cycles will not precede bleeding episodes.

  • Exclude the diagnosis of pregnancy first.

  • Address the presence of local and systemic disease. Rule out the presence of signs or symptoms indicative of bleeding disorders. Screening for personal and family history of easy bruising, bleeding gums, epistaxis, and excessive bleeding episodes during childbirth, surgery, or dental procedures may be useful.

  • Rule out iatrogenic causes of bleeding, including bleeding secondary to steroid hormone contraception, hormone replacement therapy, or other hormone treatments, which are common causes.

  • Many patients are adolescents or are older than 40 years.

Patients who report irregular menses since menarche may have polycystic ovarian syndrome (PCOS). [43] PCOS is characterized by anovulation or oligo-ovulation and hyperandrogenism. These patients often present with unpredictable cycles and/or infertility, hirsutism with or without hyperinsulinemia, and obesity. A retrospective study by Maslyanskaya et al identified 125 female patients, 8-20 years of age, who were admitted for treatment of abnormal uterine bleeding and reported that PCOS accounted for 33% of admissions and was the most common underlying etiology. Other underlying causes were hypothalamic pituitary ovarian axis immaturity (31%); endometritis (13%); and bleeding disorders (10%). [44]

Patients with adrenal enzyme defects, hyperprolactinemia, thyroid disease, or other metabolic disorders also might present with anovulatory bleeding.

Next:

Physical Examination

The physical examination can elicit several findings that suggest an etiology for AUB (see the Table below).

Table. Physical Findings in AUB (Open Table in a new window)

Examination Finding Differential
Vital signs Tachycardia

Anemia

Hypovolemia

Weight Obesity PCOS, weight-related anovulation
Eyes

Exophthalmos

Periorbital edema

Graves disease

Hypothyroidism

Neck Thyromegaly Hypothyroidism
Breasts Galactorrhea Hyperprolactinemia
Skin

Increased skin tags

Acanthosis nigricans

Hirsutism

Ecchymosis, purpura

PCOS

Insulin resistance

PCOS, CAH, Cushing syndrome, androgen-secreting tumor

Bleeding disorder

Pelvic examination

Cervical polyp/cervicitis/cervical ectropion

Globally enlarged uterus

Irregular uterus

Adnexal mass

 

Adenomyosis

Fibroids

Ovarian cyst or mass

AUB = abnormal uterine bleeding; CAH = congenital adrenal hyperplasia; PCOS = polycystic ovary syndrome.

 

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