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Abnormal Uterine Bleeding

Editor: Paul B. Sparzak Updated: 1/21/2025 8:11:33 PM

Introduction

Abnormal uterine bleeding (AUB) is a broad term that describes irregularities in the menstrual cycle involving the parameters of frequency, regularity, duration, and volume of flow outside of pregnancy in reproductive-aged women. (Please see StatPearls' companion resources, "Postmenopausal Bleeding," for more information on diagnosis and management in postmenopausal women). Up to one-third of women will experience AUB in their life, with irregularities most commonly occurring at menarche and perimenopause. A normal menstrual cycle has a frequency of 24 to 38 days and lasts 2 to 7 days, with 5 to 80 mL of blood loss. Therefore, variations in any of these 4 parameters constitute AUB.

AUB terminology and classification have evolved to promote clarity and uniformity in diagnosis. Revisions to AUB terminology were first published in 2007, followed by updates from the International Federation of Obstetrics and Gynecology (FIGO) in 2011 and 2018. In 2007, FIGO System 1 established more defined descriptive terms nongestational AUB based on the frequency, regularity, duration, and volume of flow. The nonspecific terminology of menorrhagia, metrorrhagia, and oligomenorrhea was also replaced with the terms heavy menstrual bleeding (HMB) characterized by bleeding >80 mL or heavy enough to interfere with a patient's qualify of life, intermenstrual bleeding (ie, cyclical or random spontaneous bleeding between menstrual periods) and breakthrough bleeding (BTB) on hormone medication.[1][2] (Please refer to the History and Physical section for more information on AUB descriptions). FIGO System 2 introduced PALM-COEIN, which categorizes AUB into structural (polyp, adenomyosis, leiomyoma, malignancy/hyperplasia) and nonstructural (coagulopathy, ovulatory dysfunction, endometrial, iatrogenic, not otherwise classified) etiologies.[3][4] The committee also defined irregular bleeding as any bleeding that falls outside the 5th to 95th percentiles for any menstrual parameter (eg, regularity, frequency, duration, and volume).[1]

AUB can also be divided into acute and chronic bleeding. Acute AUB is excessive bleeding that requires immediate intervention to prevent further blood loss. Acute AUB can occur on its own or superimposed on chronic AUB, which refers to irregularities in menstrual bleeding for most of the previous 6 months.[5] Understanding acute versus chronic AUB helps clinicians tailor evaluation and management strategies, ensuring optimal patient outcomes.[2] Evaluation involves a detailed history, physical examination, laboratory tests, and diagnostic imaging or endometrial sampling when indicated. Management approaches primarily treat the underlying etiology and optimize bleeding with strategies individualized based on AUB severity, cause, and patient preference.

Etiology

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Etiology

The PALM-COEIN classification, established by FIGO, organizes the potential causes of AUB into the following structural and nonstructural categories, which aids in diagnosing and managing AUB effectively:

  • Structural etiologies
    • Polyp (P): Endometrial or endocervical polyps are focal outgrowths of tissue that may be asymptomatic or cause intermenstrual bleeding. While most are benign, they occasionally carry a malignancy risk.
    • Adenomyosis (A): This condition involves the presence of endometrial tissue within the uterine muscle and is often associated with heavy, painful, or prolonged menstruation and may result in uterine enlargement.
    • Leiomyoma (L): Commonly known as fibroids, these benign smooth muscle tumors can lead to heavy or prolonged menstrual bleeding, particularly if large or submucosal. Many leiomyomas are asymptomatic.
    • Malignancy and hyperplasia (M): These include endometrial hyperplasia and cancers, often presenting with unpredictable bleeding. Risk factors include prolonged estrogen exposure without opposition by progesterone.[6][3][2]
  • Nonstructural etiologies
    • Coagulopathy (C): Systemic bleeding disorders, eg, von Willebrand disease, are common causes of heavy menstrual bleeding, particularly in adolescents and young adults.
    • Ovulatory dysfunction (O): Conditions like polycystic ovary syndrome (PCOS), hypothalamic disorders, or thyroid dysfunction can lead to infrequent, irregular, heavy, or prolonged bleeding due to inconsistent ovulation.
    • Endometrial disorders (E): These involve localized issues in the endometrium's ability to control bleeding, possibly due to inflammation, infection, or vasoconstriction abnormalities.
    • Iatrogenic (I): Medications (eg, hormonal contraceptives, anticoagulants, or tamoxifen) or surgical injury (eg, Asherman syndrome) can induce abnormal bleeding. Notably, AUB linked to anticoagulants has been reclassified under this category.
    • Not otherwise classified (N): Rare or poorly understood causes comprise this group, including arteriovenous malformations, chronic endometritis, or cesarean scar defects.[1][6][3][2]

Multiple factors may simultaneously contribute to a patient's AUB, and structural abnormalities (eg, polyps or leiomyomas) are not always the primary culprits. Diagnostic imaging techniques are vital in identifying structural causes, while nonstructural causes often require clinical and laboratory assessments for diagnosis. This array of etiologies underscores the complexity of AUB, emphasizing the need for individualized evaluation and treatment strategies.[6][3][2]

Epidemiology

The prevalence of AUB among reproductive-aged women internationally is estimated to be between 3% and 30%, with a higher incidence occurring around menarche and perimenopause. Many studies are limited to HMB, but when irregular and intermenstrual bleeding is considered, the prevalence rises to 35% or greater.[1] A survey of European women demonstrated a prevalence of 27% of HMB, while other studies found a prevalence of HMB of >50% globally.[3][6] Many women do not seek treatment for their symptoms, and some components of diagnosis are objective while others are subjective, making exact prevalence difficult to determine.[7]

Pathophysiology

The pathophysiology of AUB reflects the intricate interplay between endocrine, immune, and vascular systems in the endometrium, where disruptions in these mechanisms can lead to irregularities in menstrual bleeding. Normal menstruation involves progesterone withdrawal at the end of the menstrual cycle, triggering a well-coordinated cascade of endometrial changes. These include epithelial and stromal apoptosis, inflammatory mediator release, and matrix metalloproteinase activation, which facilitate endometrial shedding and subsequent repair. Effective hemostasis requires spiral arteriole constriction, clot formation, and tissue regeneration. In individuals with AUB, these processes are dysregulated, leading to excessive or irregular bleeding.[3][6]

AUB etiologies differ based on hormonal and structural influences, though the exact pathophysiologic mechanisms may be unclear. For instance, ovulatory dysfunction resulting in disruption of the hypothalamic-pituitary-ovarian axis arises from unpredictable progesterone withdrawal, leading to unregulated endometrial growth and shedding. In contrast, endometrial dysfunction is linked to impaired vascular and hemostatic responses, often involving diminished hypoxia signaling and abnormal endometrial repair.[3] Structural causes like fibroids and adenomyosis further complicate the picture, disrupting myometrial contractility, paracrine signaling, and vascular function. For example, fibroids may induce excessive bleeding through mechanisms, eg, increased endometrial surface area, altered angiogenesis, and impaired clotting factor expression. The precise mechanisms linking polyps to AUB have not been identified.[3][6]

History and Physical

Clinical History

The clinical assessment of AUB involves a systematic evaluation to help identify underlying causes and assess the severity of bleeding. Screening tools, eg, the Menstrual Distress Questionnaire (MEDI-Q), can help evaluate the impact of HMB on daily life, especially in patients with conditions like uterine fibroids.[3] Hemodynamic stability should be ascertained first, with resuscitative measures performed in unstable patients with acute AUB, before obtaining a thorough history. In stabilized patients, the clinician should obtain a detailed history of patients who present with complaints related to menstruation and should include the following elements:

  • Menstrual history
    • Age at menarche
    • Last menstrual period
    • Menses frequency, regularity, duration, the volume of flow
      • Frequency can be described as frequent (<24 days), normal (24 to 38 days), infrequent (>38 days), or absent (ie, amenorrhea)
      • Regularity can be described as absent, regular (with a variation of +/- 2 to 7 days), or irregular (variation >20 days)
      • The duration can be described as prolonged (>8 days) or normal (≤8 days)
      • The volume of flow can be described as heavy (>80 mL), normal (5 to 80 mL), or light (<5 mL of blood loss)
        • Exact volume measurements are difficult to determine outside research settings; therefore, detailed questions regarding the frequency of sanitary product changes during each day, passage and size of any clots, the need to change sanitary products during the night, interfering with normal activities, and a "flooding" sensation are essential.[8]
    • Intermenstrual and postcoital bleeding
  • Sexual and reproductive history
    • Obstetrical history, including the number of pregnancies and mode of delivery
    • Fertility desire and subfertility
    • Current contraception
    • History of sexually transmitted infections (STIs)
    • PAP smear history
  • Associated or systemic symptoms
    • Weight loss
    • Pain
    • Discharge
    • Bowel or bladder symptoms
    • Signs/symptoms of anemia
    • Signs/symptoms or history of a bleeding disorder
    • Signs/symptoms or history of endocrine disorders
  • Current medications
  • Family history (eg, coagulopathies, malignancy, endocrine disorders)
  • Social history (eg, tobacco, alcohol, and drug use, occupation, the impact of symptoms on quality of life)
  • Surgical history [2]

Physical Examination

Clinicians should first assess for signs of hemodynamic instability, eg, orthostatic hypotension or tachycardia.[2][9] The physical exam should target indications of a potential underlying etiology, including:

  • Vital signs, including blood pressure and body mass index (BMI)
  • Dermatologic indicators of anemia or of coagulopathies, eg, pallor, petechiae, and bruising
  • Tanner staging in adolescents to confirm that bleeding aligns with sexual maturity (eg, Tanner Stage III or above)
  • Signs of endocrine disorders
    • Examination of the thyroid for enlargement or tenderness
    • Excessive or abnormal hair growth patterns, clitoromegaly, acne, potentially indicating hyperandrogenism
    • Moon facies, abnormal fat distribution, striae that could indicate Cushing syndrome
  • Abdominal exam to palpate for any pelvic or abdominal masses
  • Pelvic exam
    • Speculum and bimanual exams should be performed
    • Pap smear and cultures for sexually transmitted infection screening (eg, gonorrhea and chlamydia) and wet prep, should be collected if indicated [10][9]

Evaluation

The diagnostic evaluation of AUB involves an integrated approach that includes laboratory testing, imaging, and endometrial assessment. This approach identifies the underlying etiology, differentiates structural from nonstructural causes, and guides effective management. 

Laboratory Studies

In all reproductive-aged women, pregnancy should be excluded using a urine or serum human chorionic gonadotropin test, and a complete blood count (CBC) should be performed to evaluate anemia and thrombocytopenia. Additional investigations that should be performed as clinically indicated include:

  • Thyroid function: Assess in patients with signs or symptoms of thyroid disease or when no apparent cause of AUB is identified.[2][9]
  • Hormonal evaluation: Specific hormonal tests (eg, prolactin, androgens, and estrogen) should be reserved for cases with clinical suspicion of endocrine dysfunction (eg, anovulation or hyperprolactinemia).[2][9]
  • Bleeding disorders: Initial screening includes platelet count, prothrombin time, and partial thromboplastin time. Since these tests may be normal in conditions like von Willebrand disease, further testing and consultation with a hematologist are often required. Evaluation of patients, especially adolescent girls, who present with HMB and any of the following should include an assessment for the presence of a bleeding disorder:
    • The duration of menses was ≥7 days, and the woman reported either gushes of blood or bleeding through a tampon or napkin in 2 hours or less with most periods
    • A history of treatment of anemia
    • A family history of a diagnosed bleeding disorder
    • A history of excessive bleeding with tooth extraction, delivery or miscarriage, or surgery [11]
  • Ferritin levels: In cases of HMB, serum ferritin levels should be assessed to evaluate iron stores. A low ferritin level indicates iron deficiency, though normal levels may not rule out anemia due to inflammatory states.[2][9]
  • Transfusion studies: Include blood type and crossmatch testing for hemodynamically unstable patients with acute HMB.[2][9]

Imaging Studies

Diagnostic imaging is primarily performed to help assess suspected structural etiologies of AUB. Imaging is indicated for abnormalities detected during a bimanual examination or when symptoms persist despite initial treatment. In adolescents, routine imaging is not recommended unless initial management fails.[9] Transvaginal (TVUS) and transabdominal ultrasound imaging modalities are preferred as first-line imaging for most patients when indicated and are particularly effective for identifying structural causes, eg, polyps, adenomyosis, or leiomyomas.[12][2][3] Transabdominal ultrasound may be more appropriate than TVUS in the adolescent population.[9]

Saline-infused sonohysterography may be considered to enhance the detection of intracavitary lesions by introducing sterile saline into the uterine cavity during TVUS; however, this method is not as useful for endometrial assessment if the endometrium was not well visualized on initial ultrasound.[12] Magnetic resonance imaging (MRI) is typically reserved for cases where TVUS is inadequate, eg, patients with complex anatomy, leiomyomas, or adenomyosis. Diffusion-weighted imaging can improve diagnostic accuracy, particularly for differentiating benign and malignant lesions.[12][2][3] 

Endometrial Biopsy

Endometrial sampling is indicated for patients aged 45 years or older with AUB, as age is a significant risk factor for endometrial cancer. Sampling is also indicated for younger patients with persistent bleeding, a history of unopposed estrogen exposure, or failure of medical management. Office-based endometrial biopsy is the first-line approach with hysteroscopic dilation and curettage recommended if office sampling fails, is inadequate, or cannot be performed.[2][3] In patients with persistent symptoms following normal biopsy results, hysteroscopy should be performed as blind sampling may miss focal lesions.[2][5] Please see StatPearls' companion resource, "Endometrial Biopsy," for further information.

Treatment / Management

Treatment decisions for AUB depend on factors such as the underlying cause and acuity of bleeding, fertility and contraceptive goals, comorbidities, treatment efficacy, adverse effects, and cost. When an identifiable cause can be treated, symptoms may resolve without additional intervention. Treatment is indicated when AUB leads to anemia or significantly impacts the patient's quality of life. Anovulatory AUB requires interventions to mitigate the effects of unopposed estrogen, eg, inducing ovulatory cycles or administering progesterone.

Management of Acute Emergent Abnormal Uterine Bleeding

For hemodynamically unstable patients with severe AUB, emergent interventions may include mechanical control with intrauterine tamponade using a balloon, Foley catheter, or gauze packing, high-dose medical interventions, eg, intravenous (IV) or oral estrogen if not contraindicated, combined oral contraceptives (COCs), oral progestins, or IV tranexamic acids. Estrogen contraindications include migraine with aura, history of thromboembolic disease or thrombosis risk factors, hypertension, and congenital cardiac anomalies.[9] In rare cases, procedures such as dilation and curettage, uterine artery embolization, or hysterectomy may be necessary.[4][2][3](B3)

Hospitalization is indicated for hemodynamically unstable patients or those with severe refractory bleeding despite outpatient management for 24 hours, including patients saturating >1 pad in an hour or bleeding through a pad within 2 hours, hemoglobin <8 g/dL, or signs of hypovolemia or orthostatic hypotension.[4][2][3] For patients with acute AUB, medical treatment depends on clinical stability and suspected etiology, including:

  • Hormonal: Conjugated estrogen 25 mg IV every 4 to 6 hours for 24 hours or 35-μg high-dose COCs 3 times daily for 7 days, then once daily, tapered after bleeding cessation. Estrogen-containing treatments are contraindicated in patients at high risk for thrombosis. Progestin-only options include medroxyprogesterone 20 mg or norethindrone 20 mg 3 times daily for 7 days.[4][2][3]
  • Nonhormonal: Tranexamic acid 10 mg/kg IV up to 600 mg per dose or 1.5 g orally every 8 hours for 5 days, and NSAIDs are effective adjuncts.[4][2][3]
  • Adjunctive measures: Supportive treatments include antiemetics for hormonal therapy-induced nausea and iron supplementation for anemia.[4][2][3]

Nonemergent Treatment of Abnormal Uterine Bleeding

Hemodynamically stable patients with severe bleeding can typically be managed with oral hormonal and nonhormonal therapies. For nonemergent AUB, medical management is preferred, particularly for patients seeking to avoid surgery and preserve fertility, including:

  • Hormonal options
    • Levonorgestrel-releasing intrauterine system (LNG-IUD): LNG-IUD 19.5- to 52-mg for 5 years are the most effective types (71% to 95% blood loss reduction) and comparable to hysterectomy in quality-adjusted life years and, therefore, should be considered as part of first-line medical treatment for chronic AUB.[5]
    • Estrogen-progestin oral contraceptives: Monophasic 30- to 35-μg estrogen-containing OCP daily with or without inert pills are effective for reducing blood loss and regulating ovulatory dysfunction (35% to 69% reduction).
    • Progestin-only therapy: Continuous oral progestins, including medroxyprogesterone 5 to 10 mg, norethindrone 5 to 10 mg daily, or depot medroxyprogesterone 150 mg subcutaneously every 3 months reduce bleeding but often result in lower patient satisfaction.
  • Nonhormonal options
    • Tranexamic acid: Tranexamic acid 1.5 g orally every 8 hours for 5 days with menses reduces blood loss by 26% to 54% and is suitable for patients attempting conception.
    • Nonsteroidal anti-inflammatory drugs (NSAIDs): Ibuprofen 600 mg every 6 hours or 800 mg every 8 hours; naproxen 500 mg initially and repeat 3 to 5 hours later, then 250 to 500 mg twice daily; mefenamic acid 500 mg 3 times daily with food. NSAIDS have been found to reduce bleeding by 10% to 52%.[4][2][3]
  • (B3)

Long-term management and maintenance therapy include hormonal therapies, including COCs, oral or injectable progestins, and LNG-IUDs. Continuous or extended regimens can stabilize bleeding, and nonhormonal treatments can be used, including oral iron and dietary optimization for anemia. Gonadotropin-releasing hormone (GnRH) agonists or antagonists are effective for fibroid-related bleeding, with options like elagolix and relugolix offering symptom relief and volume reduction, though adverse effects, eg, bone loss, necessitate "add-back" therapy (eg, estradiol 1 mg and norethisterone acetate 0.5 mg once daily).[3]

Surgical Management

Surgical management is typically reserved for patients unresponsive to medical management or desiring definitive treatment. Minimally invasive techniques are preferred for fertility preservation, emphasizing patient-specific strategies. Surgical therapies include:

  • Dilatation and curettage: Sharp endometrial curettage is an option for AUB treatment, especially in patients with clots noted within the endometrial cavity on imaging. However, this method should be avoided in patients with bleeding disorders.[9]
  • Hysterectomy: This procedure is a definitive solution with high satisfaction rates. Hysterectomy is frequently considered for adenomyosis in those who do not desire fertility conservation.
  • Endometrial ablation: Destruction of the endometrial lining is an effective alternative to hysterectomy, equivalent to LNG-IUD for outcomes, although not recommended in those desiring fertility preservation.[13]
  • Hysteroscopic or laparoscopic myomectomy: Depending on size, type, and patient goals, excising the leiomyoma while retaining the uterus may be performed to preserve fertility.
  • Hysteroscopic polypectomy: This procedure may be considered for endometrial polyp resection.
  • Uterine artery embolization: This interventional radiology procedure in which bilateral uterine arteries are catheterized and blood flow is occluded with particulate material may be considered particularly for AUB due to leiomyomas.[4][2][3]
  • (B3)

Management of Abnormal Uterine Bleeding Etiologies

Treatment strategies will vary based on the PALM-COEIN etiologies of AUB. For the following conditions, etiology-specific management includes:

  • Polyps: Treatment involves surgical resection.

  • Adenomyosis: The primary treatment is hysterectomy. In rare cases, adenomyomectomy may be performed.

  • Leiomyomas: Management can be either medical or surgical, depending on factors such as the patient's fertility desires, medical comorbidities, symptoms from uterine pressure, and distortion of the uterine cavity.

    • Surgical options: Uterine artery embolization, endometrial ablation, or hysterectomy
    • Medical options: LNG-IUD, GnRH agonists, systemic progestins, tranexamic acid, and NSAIDs
  • Malignancy or hyperplasia: Treatment includes surgery, with or without adjuvant therapy, depending on the type of malignancy and stage. For cases where surgery is not feasible, high-dose progestins or palliative treatments, eg, radiotherapy, may be considered.

  • Coagulopathies: Coagulopathies (eg, von Willebrand disease) may include treatment with tranexamic acid or desmopressin (DDAVP).

  • Ovulatory dysfunction: Management focuses on addressing underlying conditions, including lifestyle modifications for patients with obesity, PCOS, or other causes of anovulatory cycles and correction of endocrine disorders using appropriate medications, eg, cabergoline for hyperprolactinemia or levothyroxine for hypothyroidism.

  • Endometrial disorders: No specific treatments are available, as the mechanisms are not fully understood.

  • Iatrogenic causes: Management for medication-induced AUB will vary based on the causative factor and severity of bleeding. For instance, BTB following the initiation of continuous COC may only require reassurance initially. Treatment may also involve identifying and addressing the offending medication. If contraception is implicated, alternative methods (eg, LNG-IUD or systemic progestins) may be considered. If other medications are the cause and discontinuation is not an option, individual treatment plans should consider the patient's reproductive goals and medical conditions.

  • Not otherwise classified causes: Treatment is based on the condition, including antibiotics for endometritis and uterine artery embolization for AVMs.[5][10][8]

  • (B3)

Please see StatPearls' companion resources, "Bleeding Disorders", "Endometrial Cancer," "Adenomyosis," and "Leiomyoma," for further information on the management of these conditions.

Differential Diagnosis

Any bleeding from the genitourinary tract or gastrointestinal tract can mimic AUB. Therefore, bleeding from other sources fits into the differential diagnosis and must be excluded. Differential diagnosis for genital tract bleeding based on anatomic location or system include:

  • Vulva: Benign growths or malignancy
  • Vagina: Benign growths, sexually transmitted infections, vaginitis, malignancy, trauma, foreign bodies
  • Cervix: Benign growths, sexually transmitted infections, malignancy
  • Fallopian tubes and ovaries: Pelvic inflammatory disease, malignancy
  • Urinary tract: Infections, malignancy
  • Gastrointestinal tract: Inflammatory bowel disease, Behçet syndrome
  • Pregnancy and pregnancy-associated complications: Intrauterine pregnancy, spontaneous abortion, ectopic pregnancy, placenta previa
  • Uterus: Etiologies of bleeding arising from the uterine corpus are listed in the acronym PALM-COEIN [1][5][14]

Prognosis

The prognosis for AUB is favorable but also depends on the etiology. The main goal of evaluating and treating chronic AUB is to rule out serious conditions such as malignancy and improve the patient's quality of life, tailored to their current and future fertility goals and comorbid medical conditions that may impact treatment or symptoms. Prognosis also differs based on medical versus surgical treatment. Nonhormonal treatment with antifibrinolytic and NSAID medications has been shown to reduce blood loss during menstruation by up to 50%.[8] Oral contraceptive pills can be effective, but randomized trials are lacking.

For women with heavy menstrual bleeding as their primary symptom of AUB, the LNG-IUD has been proven to be more effective than other medical therapies and improves the patient's quality of life. Injectable progestogens and GnRH agonists can produce amenorrhea in up to 50% and 90% of women, respectively. However, injectable progestogens can produce BTB, and GnRH agonists are usually only used for a 6-month course due to their adverse effects associated with a low estrogen state.[8]

With the surgical techniques, randomized clinical trials and reviews have shown that endometrial ablation controlled bleeding more effectively at 4 months postoperatively, but at 5 years, no difference compared to medical management was noted. When trials have compared hysterectomy versus LNG-IUD, the hysterectomy group had better results at 1 year. No difference in the quality of life was seen at 5 and 10 years, but many women in the LNG-IUD group had undergone a hysterectomy by 10 years.[8]

Complications

Complications of chronic AUB can include anemia, infertility, and endometrial cancer. Acute AUB can result in complications associated with critical blood loss, eg, severe anemia, hypotension, renal dysfunction, shock, and even death if prompt treatment and supportive care are not initiated.[9]

Consultations

Consultations with obstetrics and gynecology should be initiated early on for proper evaluation and treatment. Depending on the etiology of AUB, other specialties may need to become involved in patient care. For coagulopathies, consultations with hematology/oncology are warranted. Interventional radiology should be consulted for uterine artery embolization procedures. Malignancy may require proper treatment for gynecologic oncology and hematology/oncology specialties.

Deterrence and Patient Education

Patient counseling and prevention of AUB should prioritize education, proactive planning, and comprehensive support. Primary care clinicians should initiate discussions with patients regarding menstrual cycles, regularity, desire for fertility, contraception, and sexual health. Patients with AUB should be counseled on maintaining open communication with clinicians, as clinic visits are vital for addressing specific concerns and optimizing management. Supportive therapies should be utilized to reduce anxiety and improve quality of life.

For those with known bleeding disorders, particularly adolescents, early counseling is essential to address the potential challenges associated with menarche and HMB. Discussions should include preparing for possible heavy bleeding, managing menstrual hygiene in school or other public settings, and recognizing common causes of bleeding, such as accidental trauma. A collaborative approach involving gynecologists, hematologists, and social workers can help create individualized care plans, empowering patients and their families to manage these concerns effectively. Interprofessional clinics, when available, offer a convenient and integrated setting for such care.[9]

Enhancing Healthcare Team Outcomes

Effective management of AUB requires a collaborative, interprofessional approach to ensure patient-centered care, optimal outcomes, and enhanced safety. Coordination among physicians, advanced practitioners, nurses, pharmacists, and other healthcare professionals is crucial in evaluating and treating women with AUB. Primary care clinicians, such as family medicine and internal medicine, often play a pivotal role in identifying AUB and should consult obstetrics and gynecology specialists promptly to initiate appropriate care. Comprehensive care involves detailed discussions with patients about their treatment options, considering the underlying etiology, desire for fertility, and medical versus surgical management preferences.

Physicians and pharmacists have an essential responsibility to educate patients on the potential adverse effects of medical treatments, fostering informed decision-making and adherence to therapy. Nurses and advanced practitioners contribute to patient education and provide emotional support, helping patients navigate the complexities of their care. Open and consistent interprofessional communication ensures that all team members are aligned in their approach, minimizing errors and enhancing the quality of care. By integrating expertise across disciplines, health professionals can effectively address AUB, prioritize patient safety, and achieve better clinical and reproductive outcomes while optimizing team performance.

References


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