Abnormal uterine bleeding

1. Big picture

Abnormal uterine bleeding (AUB) means bleeding from the uterine corpus that is abnormal in frequency, regularity, duration, or volume in a non-pregnant woman. Clinically, however, the first rule is:

In every reproductive-age woman with abnormal bleeding, exclude pregnancy first.

AUB is one of the most common gynaecological complaints. The final-exam goal is to show that you can:

1. Recognize the bleeding pattern.
2. Exclude pregnancy-related bleeding.
3. Identify acute haemorrhage and stabilize first.
4. Classify causes using PALM-COEIN.
5. Choose the right investigation: pregnancy test, blood count, ultrasound, hysteroscopy, endometrial biopsy.
6. Treat according to age, severity, fertility wish, structural cause, and malignancy risk.

Core clinical flow:

Abnormal bleeding
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Is she pregnant?
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Is she haemodynamically stable?
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What is her age/reproductive stage?
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Is bleeding structural, hormonal, systemic, iatrogenic, or malignant?
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Treat acute bleeding first, then investigate and manage cause

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