Definitions

• Menorrhagia: prolonged and increased menstrual flow
• Menorrhagia: regular menstrual bleeding
• Polymenorrhoea: menses occuring at < 21 day interval
• Menometrorrhagia: prolonged menses and intermenstrual bleeding
• Amenorrhoea: absence of menstruation > 6 months
• Oligomenorrhoea: menses at intervals of > 35 days
• AUB: includes all causes of abnormal uterine bleeding
• Dysfunctional uterine bleeding (DUB): AUB with no organic cause - reflects a disruption in the normal cyclic pattern of ovulatory hormonal stimulation to the endometrial lining
  • Most cases due to anovulatory cycles, which are most common at either end of reproductive life
• Post-menstrual bleeding (PMB): AUB > 1 year after cessation of menstruation

Aetiology

• Causes in reproductive years include pregnancy/miscarriage, endometritis, endometrial/endocervical polyp, leiomyoma, bleeding disorders, hyperplasia, neoplasia (cervical, endometrial)
  • Endometrial hyperplasia: cause is often unknown; can be simple, complex, or atypical (precursor of adenocarcinoma)
• Causes of post-menopausal AUB include atrophy, endometrial polyp, exogenous hormones (HRT, tamoxifen), endometritis, bleeding disorders, hyperplasia, endometrial carcinoma, sarcoma

Clinical features

• Vaginal bleeding outside of the regular menstrual cycle

Investigations

• Transvaginal US: assess endometrial thickness
  • Endometrial thickness of >4mm in postmenopausal women (16mm in premenopausal) is generally taken as an indication for biopsy
• Hysteroscopy: can also be used to assess for endometrial abnormalities
  • Sampling methods: endometrial pipelle, dilation and curretage

Management

• Depends on underlying cause