TERMINOLOGIES AND CLASSIFICATION
Polyps (AUB-P)
o Polyps in the endometrium that are diagnosed by
ultrasound or hysteroscopy.
o Associated with Tamoxifen.
o Increased risk of Malignant/Pre-Malignant Change in
postmenopausal women.
o Recognized structural abnormalities causing AUB.
o Found in all age groups, but mostly in older women.
o Present as heavy menstrual, intermenstrual, or
post-menstrual bleeding associated with
Dysmenorrhea.
o AUB-P1 Present
o AUB-P0 Absent
Adenomyosis (AUB-A)
o Adenomyosis which can be most accurately
diagnosed on the basis of tissue analysis of a
hysterectomy specimen, but MRI and Ultrasound
are used to established the diagnosis.
o Hypotheses:
Increased Endometrial Surface
Altered PGE/PGF2
Hampered Myometrial Contractility
Abnormal Myometrial Angiogenesis
associated with Fragile Blood Vessels
o AUB-A1
Leiomyoma (AUB-L)
o Leiomyomas, solitary or multiple, can be located
close to the cavity (Submucosal), in the
myometrium (Subserosal), or independent of the
uterus (Parasitic).
SUBMUCOSAL most likely to cause
bleeding
o Heavy Menstrual Bleeding may cause Anemia.
o Myoma-related AUB may result from:
Increased Endometrial Surface Area due to
Mechanical Distortion.
Ulceration & Hemorrhage of Endometrium
overlying the Submucous Fibroids.
Interference by the Myomas with normal
Uterine Hemostasis.
Mechanical compression of the Venous
Drainage by the Myomas at any site.
Dilation of the Venous Plexuses draining the
Endometrium.
o Primary Classification: Reflects the presence (AUB-
L1) or absence (AUB-L0) of the Leiomyoma,
regardless of the location, number, & size,
confirmed on Ultrasound Examination.
o Secondary Classification: Differentiates
Leiomyomas involving the Endometrial Cavity.
SM Submucosal
O Others
SM 0 Pedunculated Intracavitary
(Submucos 1 < 50% Intramural
al)
2 50% Intramural
3 Contacts Endometrium (100%
Intramural)
O 4 Intramural
(Others) 5 Subserosal 50% Intramural
6 Subserosal < 50% Intramural
7 Subserosal Pedunculated
8 Others (e.g. Cervical, Parasitic,
etc.)
Malignancy (AUB-M)
o Malignancyc, inducing hyperplasia and endometrial
cancer. The diagnosis requires the histologic
analysis of a biopsy sample
Coagulopathy (AUB-C)
o Encompasses the spectrum of Systemic Disorders
of Hemostasis, 13% prevalence rate of the
biochemical markers of von Willebrand Disease
among women with HMB.
o Women on chronic Anti-Coagulant Drugs (Warfarin,
Heparin, Low Molecular Weight Heparin)
o Coagulopathy, which in most cases is diagnosed in
adolescents.
o von Willebrand Disease
Most common inherited blooding disorder
Incidence: 1:100 1:1000
Quantitative Defects: Type 1 & Type 3
Qualitative Defects: Type 2
Easy bruising & mucocutaneous bleeding
Defective primary hemostasis
Decreased adherence to vascular
injury
Inadequate platelet plus prolongs
bleeding time
o vWD: Diagnosis
Normal Platelet Count (except Type 2B)
Low to Normal Factor VIII Activity (10-40%)
vWF Antigen
vWF Activity (Rotacetin Co-Factor Activity)
Prolonged Bleeding Time
Normal Coagulation Time (aPTT, PT)
Rotacetin Induced Platelet Aggregation
RIPA (+) in Type 2B (negative in other
types)
Ovulatory Dysfunction (AUB-O)
o Ovulatory dysfunction, in which cycle length and
volume of flow are unpredictable.
o Usually manifests as a combination of
unpredictable bleeding & variable amount of flow.
o Most common after Menarche (Immature HPO Axis)
or just before Menopause (decline in Inhibin & rise
in FSH result in disturbed Ovulations) but may
occur in other times.
o Exact etiology is unknown but some may be due to
Endocrinopathies:
PCOS
Hypothyroidism
Hyperprolactinemia
Mental Stress
Obesity
Anorexia
Weight Loss
Extreme Exercise
Endometrial Dysfunction (AUB-E)
o Endometrial problems, typically related to abnormal
prostaglandin synthesis, but which could be the
result of infection as well.
Iatrogenic (AUB-I)
o Iatrogenic causes, which are typically the result of
exogenous hormone administration or
anticoagulant therapy.
o Contraceptive Hormones, IUD, Steroids,
Tranquilizers, Digitalis, Dilantin, Rifampicin, &
Griseofulvin
Non-Classified (AUB-N)
o Non-classified causes such as arteriovenous
malformations and myometrial hypertrophy