{"id":3672,"date":"2022-05-03T11:47:20","date_gmt":"2022-05-03T10:47:20","guid":{"rendered":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/abnormaluterinebleeding\/"},"modified":"2023-08-30T15:10:14","modified_gmt":"2023-08-30T14:10:14","slug":"abnormaluterinebleeding","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/gynaecology\/abnormaluterinebleeding\/","title":{"rendered":"Abnormal Uterine Bleeding"},"content":{"rendered":"\nAbnormal Uterine Bleeding<\/title>\n\n\n\n<h4 class=\"wp-block-heading\">Includes Heavy Menstrual Bleeding ( Mennorhagia ), Irregular,  Intermenstrual and Post Coital Bleeding<\/h4>\n\n\n\n<h4 class=\"wp-block-heading\">Normal Menstrual Cycle<\/h4>\n\n\n\n<p>A \u201cnormal\u201d menstrual cycle is defined based on 4 parameters (frequency, regularity, duration, or volume) summarised in the table below<\/p>\n\n\n\n<figure class=\"wp-block-table\"><table><tbody><tr><td><strong>\u200bParameter Normal Limits<\/strong><\/td><td><strong>\u200b(5th to 95th centile)<\/strong><\/td><\/tr><tr><td>Frequency of menses (days)<\/td><td>24 to 38 days<\/td><\/tr><tr><td>Regularity (Cycle length)<\/td><td>\u22647 to 9 days<\/td><\/tr><tr><td>Duration (days of bleeding in a single menstrual period)<\/td><td>\u22648 days<\/td><\/tr><tr><td>\u200bVolume (monthly blood loss)<\/td><td>\u200b<span>Clinical definition is subjective and<br>defined as a \nvolume of menstrual blood loss that does not interfere with a woman’s \nphysical, social, emotional, and\/or quality of life<\/span><\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\">Abnormal Uterine Bleeding <\/h2>\n\n\n\n<p>is the overarching term used to describe any symptomatic variation from normal menstruation and also includes intermenstrual bleeding. The Table below  summarises the recommended terminology for women with AUB.<\/p>\n\n\n\n<figure class=\"wp-block-table\"><table><tbody><tr><td><strong>Parameters <\/strong><\/td><td><strong>Terminology <\/strong><\/td><td><strong>Out with 5th to 95th centile<\/strong><\/td><\/tr><tr><td>Frequency of menses (days)<\/td><td>Absent <\/td><td>Amenorrhoea \u2013 Primary or Secondary <\/td><\/tr><tr><td> <\/td><td>Infrequent <\/td><td>>38 days<\/td><\/tr><tr><td> <\/td><td>Frequent<\/td><td> <24 days<\/td><\/tr><tr><td>Regularity (Cycle length)<\/td><td>Irregular<\/td><td>Variation <span style=\"text-decoration:underline\">><\/span>10 days  – Cycle length is the number of days from the first day of one menstrual cycle to the first day of the next<\/td><\/tr><tr><td>Duration (days of bleeding in a single menstrual period)<\/td><td>Prolonged<\/td><td>> 8 days<\/td><\/tr><tr><td>Volume (monthly blood loss)<\/td><td>Heavy or light<\/td><td>Subjectively defined<\/td><\/tr><tr><td>Spontaneous bleeds occurring in between periods <\/td><td>Intermenstrual<br> bleeding<br> (IMB)<\/td><td>Cyclic (early, mid, late cycle) or random, Midcycle IMB may represent a nadir in estradiol levels (ovulation) and is physiological (9% of women).<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<h4 class=\"wp-block-heading\">Causes – See Fig Below PALM- COEIN System to identify potential Causes of AUB <br><\/h4>\n\n\n\n<figure class=\"wp-block-image\"><img decoding=\"async\" src=\"\/files\/sites\/2\/Gynae-Abnormal-Uterine-Bleeding-causes-PALM-COEIN.png\" alt=\"Gynae Abnormal Uterine Bleeding causes PALM COEIN\"><\/figure>\n\n\n\n<p><span><span>Diagram reproduced from “Biomarkers\n in abnormal uterine bleeding -Rohan Chodankar, Hilary O D Critchley \nBiology of Reproduction\/ ioy231, https:\/\/doi.org\/10.1093\/biolre\/ioy231<\/span><\/span><br><\/p>\n\n\n\n<div class=\"wp-block-getwid-tabs\" data-active-tab=\"0\"><ul class=\"wp-block-getwid-tabs__nav-links\"><\/ul>\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Resources and Links<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p>See Risk assessment for STI and Chlamydia referral guidance on the\u00a0<a rel=\"noreferrer noopener\" href=\"\/refhelp\/guidelines\/SexuallyTransmittedInfectionsSTI\" target=\"_blank\">STI RefHelp page<\/a><\/p>\n\n\n\n<p>\u200b<a href=\"\/files\/sites\/2\/Gynae-Menstrual_Record_Card.doc\" target=\"_blank\" rel=\"noreferrer noopener\">Monthly menses chart<\/a><a href=\"\/files\/sites\/2\/Gynae-menstrual_blood_loss_chart.doc\" target=\"_blank\" rel=\"noreferrer noopener\">Menstrual blood loss chart<\/a><\/p>\n<\/div><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Abnormal Uterine Bleeding Includes Heavy Menstrual Bleeding ( Mennorhagia ), Irregular,  Intermenstrual and Post Coital Bleeding Normal Menstrual Cycle A “normal” menstrual cycle is defined based on 4 parameters (frequency, regularity, duration, or volume) summarised in the table below ​Parameter Normal Limits ​(5th to 95th centile) Frequency of menses (days) 24 to 38 days Regularity<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":3976,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"categories":[221],"class_list":["post-3672","page","type-page","status-publish","hentry","category-abnormal-uterine-bleeding"],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"NHS Lothian","author_link":"https:\/\/apps.nhslothian.scot\/refhelp\/author\/nhs-lothian\/"},"rttpg_comment":0,"rttpg_category":" <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/gynaecology\/abnormal-uterine-bleeding\/\" rel=\"tag\">Abnormal Uterine Bleeding<\/a>","rttpg_excerpt":"Abnormal Uterine Bleeding Includes Heavy Menstrual Bleeding ( Mennorhagia ), Irregular,  Intermenstrual and Post Coital Bleeding Normal Menstrual Cycle A “normal” menstrual cycle is defined based on 4 parameters (frequency, regularity, duration, or volume) summarised in the table below ​Parameter Normal Limits ​(5th to 95th centile) Frequency of menses (days) 24 to 38 days Regularity","_links":{"self":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3672","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/comments?post=3672"}],"version-history":[{"count":7,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3672\/revisions"}],"predecessor-version":[{"id":14596,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3672\/revisions\/14596"}],"up":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3976"}],"wp:attachment":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/media?parent=3672"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/categories?post=3672"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}