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Abnormal Uterine Bleeding in Pre-Menopausal Women




Abnormal uterine bleeding (AUB) is a common condition affecting womenof reproductive age that has significant social and economic impact. Pre-menopausal abnormal uterine bleeding can be ovulatory, anovulatory, or anatomic 


Diagnostic Criteria


Ovulatory might be associated with 

  • Premenstrual symptoms 

  • Dysmenorrhea 



  • Irregular bleeding, often heavy 

  • endometrial hyperplasia




  • Fibroids, polyps, or adenomyosis 

  • Often heavy bleeding, pain 

  • Uterus might be enlarged




  • A complete blood count (CBC) 

  • Pregnancy test 

  • Cervical and vaginal swab

  • Ultrasound

  • Testing for coagulation disorders should be considered only in women who have a history of heavy menstrual bleeding beginning at menarche or who have a personal or family history of abnormal bleeding

  • Other investigations might be done on the basis of clinical suspicions 


Pharmacological Treatment


The treatment will depend of the causative factor.  


Mefenamic acid (250 mg) 


Ibuprofen (200–400 mg)1–2 tablets before or at beginning of menses, then 1 tablet every 6–8 hours for 5days

Tranexamic acid (500 mg–1000 mg every 6–8 hours as required 

Combined oral contraceptives:

  • Useful for anovulatory bleeding, might have benefit for ovulatory bleeding

  • Medroxyprogesterone acetate (5–10 mg/d for 10–14 days initially and repeated for 10 days each month thereafter 



  • AUB in the adolescent most commonly represents ovulatory dysfunction related to immaturity of the hypothalamic-pituitary-ovarian axis

  • Selection of a medical therapy for AUB in adolescents should consider the need for contraception. Long acting reversible contraception may be considered first line therapy for both sexually active adolescents and, with individualized counseling, non-sexually active adolescents


Surgical management


AUB not responding to medical treatment may be due to intracavitary lesions such as submucosal fibroids. AUB secondary to submucosal fibroids may be managed by hysteroscopy myomectomy.


Updated on, 3.11.2020


1. STG

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