Abnormal uterine bleeding

Introduction Abnormal uterine bleeding (AUB) is a common and vexing problem. In England, approximately 30 per 1000 women consult their general practitioners for evaluation of abnormal uterine bleeding every year. Approximately 20% of referrals from general practitioners to gynecologists are for AUB, and of those referred, approximately 50% undergo hysterectomy. Approximately 11% of hysterectomies performed in the USA are for abnormal bleeding. Abnormal uterine bleeding has significant economic impact, with work loss estimated to be almost US$1700 annually for a woman with menorrhagia. In the UK, 3.5 million work-days are lost per year because of excessive menstrual bleeding, and over 13 000 surgical procedures were performed in 2002 for heavy menstrual bleeding. Scope and definitions Uterine bleeding associated with early pregnancy may be caused by threatened abortion, incomplete abortion, or ectopic pregnancy. This chapter is concerned with AUB in nonpregnant, reproductive-aged women and will concentrate on the differential diagnosis, evaluation, and medical treatment. A number of articles have discussed the pathophysiology of AUB. An effort has been made to reach an international consensus regarding English terminology for AUB. The final recommendation was to avoid terms such as “menorrhagia” and “dysfunctional uterine bleeding” because they are ill-defined and used differently in different parts of the world.