Summary
Definition
History and exam
Other diagnostic factors
- use of medications
- menstrual irregularity
- anemia
- premenstrual molimina
- hirsutism, acne, acanthosis nigricans
- existing medical illness
Risk factors
- women at the extremes of reproductive age (just after puberty and before menopause)
- polycystic ovary syndrome
- endocrine disorders
- other anovulatory disorders
- obesity
Diagnostic tests
Tests to consider
- coagulation profile
- serum TSH level
- ultrasound scan
- hysteroscopy
- endometrial biopsy
Treatment algorithm
Contributors
Authors
Janesh Gupta, MSc, MD, FRCOG
Professor of Obstetrics and Gynaecology
Centre for Women's and Newborn Health
Institute of Metabolism and Systems Research
University of Birmingham
Birmingham Women’s and Children’s Hospital
Birmingham
UK
Disclosures
JG is a clinical advisor for Femcare UK.
Akanksha Sood, MBBS, MS (OBGY), DNB, MRCOG, FACOG
Senior Clinical Fellow
Department of Reproductive Medicine
St. Mary’s Hospital
Manchester
UK
Disclosures
AS declares that she has no competing interests.
Rohan Chodankar, MBBS, MD, MRCOG
ST6 Obstetrics and Gynaecology
Royal Infirmary of Edinburgh
Scotland
UK
Disclosures
RC is supported as a Clinical Research Fellow by Bayer AG; RC is an author of references cited in this topic.
Acknowledgements
Professor Gupta, Dr Sood, and Dr Chodankar would like to gratefully acknowledge Dr Mohamed Mitwally and Dr Intisar Elnahhas, the previous contributors to this topic.
Disclosures
MM owns a patent on the use of aromatase inhibitors for endometrial thinning before hysteroscopic surgery. The patent is licensed to Meditrina Company. IE declares that she has no competing interests.
Peer reviewers
Janet Albers, MD
Associate Professor
Department of Family and Community Medicine
Southern Illinois University School of Medicine
Springfield
IL
Disclosures
JA is an author of a reference cited in this topic.
Sarina Schrager, MD, MS
Associate Professor (CHS)
Department of Family Medicine
University of Wisconsin
WI
Disclosures
SS declares that she has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
Munro MG, Critchley HO, Broder MS, et al. FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age. Int J Gynaecol Obstet. 2011 Apr;113(1):3-13. Abstract
National Institute for Health and Care Excellence. Heavy menstrual bleeding: assessment and management. May 2021 [internet publication].Full text
American College of Obstetricians and Gynecologists. ACOG practice bulletin no. 128: diagnosis of abnormal uterine bleeding in reproductive-aged women. Jul 2012 [internet publication].Full text
American College of Obstetricians and Gynecologists. ACOG committee opinion no. 557: management of acute abnormal uterine bleeding in nonpregnant reproductive-aged women. Apr 2013 [internet publication].Full text
American College of Obstetricians and Gynecologists. Practice bulletin no. 136: management of abnormal uterine bleeding associated with ovulatory dysfunction. Jul 2013 [internet publication].Full text
Reference articles
A full list of sources referenced in this topic is available here.
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