Causes of Abnormal Uterine Bleeding

Abnormal bleeding is one of the most common reasons why women see their gynecologist.
What is normal uterine bleeding?
• Menses should occur once every month
• Cycles usually occur every 21 to 35 days
• Menses typically lasts 4-7 days
• Bright red blood
What is abnormal bleeding?
• Heavy menstrual bleeding is bleeding that interferes with a women's quality of life
• In medicine, we define this as menstrual blood loss greater than 80 ml
• Bleeding in between periods
• Bleeding that occurs more often than every 21 days
• Bleeding after sexual relations
Symptoms of abnormal bleeding
• Dizziness, light headedness
• Pica symptoms
• Pica: craving ice or dirt (clay)
What are doctors looking for whey they ask you questions?
• History of anemia
• Heaving bleeding after surgery
• Family history of bleeding disorders
• Wearing pads and tampons together to prevent "accidents"
• Soaking more than one pad an hour for two straight hours
• A gush or "flooding" during your cycle
• Excessive bleeding after dental surgery or frequent gum bleeding
• Heavy bleeding after a miscarriage or vaginal delivery
• Easy bruising
Causes of abnormal bleeding: PALM COEIN system
• In 2011 the PALM-COEIN acronym was introduced by the International Federation of Gynecology and Obstetrics (FIGO)
• PALM-COEIN
 Polyp
 Adenomyosis
 Leiomyoma (fibroid)
 Malignancy (cancer, hyperplasia)
 Coagulopathy
 Ovulatory dysfunction
 Endometrial
 Iatrogenic
 Not yet classified (unknowns)
COEIN
Coagulopathy
1. 20% of adolescents with prolonged heavy menses at menarche have coagulation disorders
2. von Willebrand's disease
o 11% of all women with heavy bleeding
o Affects 1% of the US population
o Inheritable bleeding disorder
o Women with vWD have a missing or low level of a clotting protein called von Willebrand factor
o Women with wVD are not able to form a platelet plug or it takes longer for the platelet plug to form causing abnormal bleeding.
o Names after the Finnish physician Erik von Willebrand who first described it in the 1920s
o Refer to a hematologist
o Treatment depends of the severity of vWD and the type of vWD
3. Prothrombin deficiency
4. Disorders of platelets
5. Chronic anticoagulation (blood thinners/medication)
Ovulatory dysfunction
1. Continuous estrogen production without progesterone production
2. Common during extremes of reproductive life
o First few years after menarche
o During perimenopause
3. Patients may have infrequent cycles, bleeding in between cycles or heavy cycles
4. PCOS
o Polycystic ovarian syndrome
o Acne, hirsutism, obesity
5. Hypothyroidism
o Low thyroid levels
6. Hyperprolactinemia
o Elevated prolactin level
7. Hypercortisolism (Cushing syndrome) is rare.
Endometrial
1. Diagnosis of exclusion
2. No other findings
3. Underlying disorders of the endometrium
4. Subclinical infection with chlamydia can cause abnormal uterine bleeding
Iatrogenic
Due to medications
o Long-acting contraception (IUD)
o Chronic progesterone treatment
o Nexplanon, 40% of patients may have irregular bleeding
o OCPs 40% of patients may have break through bleeding
Unknown or Not Otherwise Specified
1. Trauma
2. Foreign body
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About Me
Dr. duPont is board certified in gynecologic oncology by the American Board of Obstetrics and Gynecology. Her practice focuses on the diagnosis, treatment and management of gynecologic malignancies, high risk ovarian cancer syndromes and precancerous conditions. She also has an interest in alleviating menopausal symptoms in all women but especially in cancer survivors. Dr. duPont is a certified menopause practitioner with The Menopause Society.
She earned her undergraduate degree in chemistry from the University of Virginia and her medical degree from Texas A&M University's College of Medicine and her master's in public health degree from the University of North Carolina at Chapel Hill. In addition to being recognized for her involvement in clinical research, Dr. duPont has authored and co-authored numerous journal articles. In 2012, she won the Gynecologic Oncology Group's Young Investigator Award.
Dr. duPont currently practices in The Woodlands, Texas at the North Houston Gynecologic Oncology Surgeons, PLLC. She loves to educate women of all ages and to empower them to lead healthy and fulfilling lives.
This channel is for educational purposes only and it is not intended as medical advice. Please consult your health care provider for treatment options tailored to your individual needs.
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