Abnormal uterine bleeding

P. I. Wathen, Mark C Henderson, C. A. Witz

Research output: Contribution to journalArticle

32 Citations (Scopus)

Abstract

Concerns about abnormal menstrual bleeding are a common reason for women to consult a primary care physician. The first step in the evaluation is to determine the patient's ovulatory status. Women with heavy bleeding but normal ovulatory cycles should be evaluated for coagulopathies, structural lesions, and hypothyroidism. In the absence of a systemic or structural cause, menorrhagia can be treated with OCPs or NSAIDs. Intermenstrual bleeding in OCP users may be due to noncompliance or the use of low-dose pills. Encouraging patient compliance and adjustment of the estrogen dose can often solve the problem. If the patient is not on OCPs, intermenstrual bleeding is usually due to a structural or inflammatory lesion. The differential diagnosis for anovulatory bleeding is extensive. Pregnancy, systemic illnesses, and structural lesions should be ruled out by history, physical examination, and laboratory evaluation. Endometrial biopsy is indicated in patients over age 35 and younger patients with risk factors for endometrial cancer, such as chronic anovulation and obesity. Dysfunctional uterine bleeding is a nonspecific term for abnormal uterine bleeding in the absence of systemic or structural disease. It is usually associated with anovulation. Adolescents frequently have dysfunctional uterine bleeding owing to immaturity of the hypothalamic-pituitary-ovarian axis. Perimenopausal women have an increased incidence of irregular bleeding secondary to decreased estrogen production by the ovary. Obesity, polycystic ovary syndrome, stress, crash diets, and vigorous exercise can all disrupt normal ovulatory function. Treatment options for dysfunctional uterine bleeding include oral contraceptives, cyclic progesterone, or hormone replacement with estrogen and progesterone. Patients with structural lesions or those who do not resume normal withdrawal bleeding patterns on hormone therapy should be referred to a gynecologist for further evaluation and treatment.

Original languageEnglish (US)
Pages (from-to)329-342
Number of pages14
JournalMedical Clinics of North America
Volume79
Issue number2
StatePublished - 1995
Externally publishedYes

Fingerprint

Metrorrhagia
Uterine Hemorrhage
Hemorrhage
Anovulation
Progesterone
Estrogens
Obesity
Hormones
Menorrhagia
Social Adjustment
Estrogen Replacement Therapy
Polycystic Ovary Syndrome
Primary Care Physicians
Non-Steroidal Anti-Inflammatory Agents
Endometrial Neoplasms
Patient Compliance
Oral Contraceptives
Hypothyroidism
Physical Examination
Ovary

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Wathen, P. I., Henderson, M. C., & Witz, C. A. (1995). Abnormal uterine bleeding. Medical Clinics of North America, 79(2), 329-342.

Abnormal uterine bleeding. / Wathen, P. I.; Henderson, Mark C; Witz, C. A.

In: Medical Clinics of North America, Vol. 79, No. 2, 1995, p. 329-342.

Research output: Contribution to journalArticle

Wathen, PI, Henderson, MC & Witz, CA 1995, 'Abnormal uterine bleeding', Medical Clinics of North America, vol. 79, no. 2, pp. 329-342.
Wathen, P. I. ; Henderson, Mark C ; Witz, C. A. / Abnormal uterine bleeding. In: Medical Clinics of North America. 1995 ; Vol. 79, No. 2. pp. 329-342.
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