Here are some summary points:
Typical presentations of AUB:
- irregular periods, heavy periods
- abdominal cramping or dysmenorrhea
- fatigue
- dizziness
- pelvic pain or pressure
- missing work or school
AUB is subjective-- normal uterine bleeding is a 28 to 30 day cycle but definitions of "normal blood flow" is really based on a woman's "normal" menstrual cycle is.
Women should be treated for AUB if/when they request treatment and/or if it is adversely affecting their life--i.e. missing work or school. Unless a woman has symptomatic anemia due to her AUB, surgery is an elective procedure.
Diagnostic work-up AUB:
- medical, surgical, and OB history
- pelvic exam
- pelvic ultrasound (BEST imaging for gyn organs)
- CBC, TSH, pregnancy test (+coagulopathy workup particularly if young/teenage)
- up to date pap smear
- Endometrial biopsy advised (if >45 and/or risk factors)
Ddx:
PALM (structural)-COIEN (non-structural)
polyp, adnenomyosis, leiomyoma, malignancy or hyperplasia
coagulopathy, ovulatory dysfunction, endometrial, iatrogenic, not-yet-classified
Treatment options for AUB:
- Combined oral contraceptives (birth control pills)
- Tranexemic acid (TXA), used only during menses (slight increase risk of VTE)
- Progesterone IUD (Mirena, skyla)
- Hysteroscopy D&C
- Uterine ablation
- Myomectomy
- Hysterectomy
Recovery from surgical intervention:
- Hysteroscopy: outpatient surgery, bleeding and cramping, nothing vaginally x2 weeks
- Uterine ablation: outpatient surgery, discolored vaginal discharge, nothing vaginally x 2 weeks
- Myomectomy: depends on location (hysteroscopy vs. mini-laparotomy)
- Hysterectomy: can be done outpatient (or overnight stay), most done laparascopically/robotically, pelvic organs removed through vagina IF cervix also removed
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