Menorrhagia: prolonged and increased menstrual flow
Menorrhagia: regular menstrual bleeding
Polymenorrhoea: menses occuring at < 21 day interval
Menometrorrhagia: prolonged menses and intermenstrual bleeding
Amenorrhoea: absence of menstruation > 6 months
Oligomenorrhoea: menses at intervals of > 35 days
AUB: includes all causes of abnormal uterine bleeding
Dysfunctional uterine bleeding (DUB): AUB with no organic cause - reflects a disruption in the normal cyclic pattern of ovulatory hormonal stimulation to the endometrial lining
Most cases due to anovulatory cycles, which are most common at either end of reproductive life
Post-menstrual bleeding (PMB): AUB > 1 year after cessation of menstruation
Aetiology
Causes in reproductive years include pregnancy/miscarriage, endometritis, endometrial/endocervical polp, leiomyoma, bleeding disorders, hyperplasia, neoplasia (cervical, endometrial)
Causes of post-menopausal AUB include atrophy, endometrial polyp, exogenous hormones (HRT, tamoxifen), endometritis, bleeding disorders, hyperplasia, endometrial carcinoma, sarcoma
Pathophysiology
Endometrial hyperplasia
Cause is often unknown, may be persistent oestrogen stimulation
Presents with abnormal bleeding (dysfunctional uterine bleeding or postmenopausal bleeding)
Can be simple, complex, or atypical (precursor of adenocarcinoma)
Clinical presentation
Vaginal bleeding outside of the regular menstrual cycle
Investigations
Endometrial thickness can be assessed using TVUS
Endometrial thickness of >4mm in postmenopausal women (16mm in premenopausal) is generally taken as an indication for biopsy
Hysteroscopy can also be used to assess for endometrial abnormalities
Sampling methods: endometrial pipelle, dilation and curretage
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