Seeking medical options for abnormal uterine bleeding

November 1, 2005

Determining the cause of AUB is challenging. How you choose to manage it will partly depend on whether the bleeding is acute or chronic. In part 1 of this 2-part series, we'll discuss medical treatment. In part 2, we'll address surgical options.

About one out of every five women of reproductive age suffers from menorrhagia, which translates into about 2.7 million office visits in the United States each year.¹ Of course, "menorrhagia" is only one of several confusing terms used to define the various forms of abnormal uterine bleeding (AUB), as Table 1 illustrates.

Given the confusion surrounding the nomenclature of AUB, it's important for clinicians to take a structured approach to the problem. A detailed history will clarify the time sequence of the bleeding to determine if it's cyclic or noncyclic. Determining the amount of bleeding is more difficult. Patients often over-and underestimate the amount of blood they lose.⁵ Although pad counts can help, they too can be unreliable given differences in pad absorbency and interpersonal variation in hygiene and pad changing behaviors. For clinical studies, menstrual blood loss per cycle has been measured by the alkaline hematin method or the pictorial chart method.^6,7 You'll also want to take a thorough medical history to search for organic causes of AUB. A family history of bleeding disorders or gynecologic problems can be helpful. It is important to establish any relationship between bleeding and intercourse. A review of systems may elicit undiagnosed conditions that may be related to AUB, including the presence of fever, pain, bowel/bladder changes, weight changes, galactorrhea, or hirsutism.