Defined as any symptomatic variation from normal menstruation including intermenstrual bleeding. Examples include heavy menstrual bleed, frequent bleed, infrequent.

is commonly due to uncontrolled endometrial proliferation (from unregulated excess estrogen) and is associated with an increased risk of endometrial hyperplasia/cancer.

chronic (≥6 months)

Abnormal uterine bleeding should be suspected when bleeding is irregular, unpredictable, or not associated with usual premenstrual signs and symptoms (eg, bloating, breast fullness, uterine cramps). It may be caused by malignancy, structural abnormalities (eg, cervical or endometrial polyps), adenomyosis, endometrial hyperplasia, inflammation or infection of the genital tract, coagulopathy, ovulatory dysfunction, and endocrine dysfunction (eg, thyroid disorders, prolactin, androgens), and may be iatrogenic or idiopathic.

• Causes (PALM COEIN)
• Evaluation

<aside> 💡 Undiagnosed AUB is a contraindication to endometrial ablation because it can prevent evaluation of the endometrium in patients with possible endometrial hyperplasia/cancer.

is a relative contraindication to a hysterosalpingogram because the procedure could spread cancerous endometrial cells into the abdomen.

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• Management
• EDUCATIONAL OBJECTIVES

(Choice D)  Von Willebrand disease (eg, impaired platelet adhesion) can present with heavy menstrual bleeding; however, there is also typically a history of recurrent epistaxis, easy bruising, and gingival bleeding, which are not seen in this patient.