Definition of aub

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Reading File

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Reading File

Here is a thorough definition and overview of AUB from multiple authoritative textbooks:

Abnormal Uterine Bleeding (AUB)

Definition

Abnormal Uterine Bleeding (AUB) is an overarching clinical term defined as bleeding from the uterine corpus that is irregular in volume, frequency, or duration, in the absence of pregnancy.

A normal menstrual cycle occurs every 24-38 days, with flow lasting 4-8 days, and blood loss ≤ 80 mL
Any bleeding that deviates from these parameters - in amount, timing, regularity, or duration - is classified as AUB

The older terms menorrhagia, metrorrhagia, menometrorrhagia, and dysfunctional uterine bleeding are no longer recommended. AUB is the preferred modern term. - Tintinalli's Emergency Medicine; Rosen's Emergency Medicine

Types of AUB

Type	Description
AUB/HMB	Heavy menstrual bleeding - excessive in volume, affecting quality of life
AUB/IMB	Intermenstrual bleeding - occurs between regular cycles
Acute AUB	A single episode of heavy bleeding requiring immediate intervention
Chronic AUB	Abnormal bleeding present for most of the previous 6 months

PALM-COEIN Classification (FIGO 2011)

The ACOG/FIGO PALM-COEIN system (adopted 2011) classifies causes into structural and non-structural groups:

PALM - Structural causes (diagnosed by imaging or histology):

P - Polyps (endometrial polyps; ~25% of AUB cases)
A - Adenomyosis (ectopic endometrial glands within the myometrium)
L - Leiomyoma (uterine fibroids; most common indication for hysterectomy in the US)
M - Malignancy and Hyperplasia (endometrial carcinoma, hyperplasia)

COEIN - Non-structural/medical causes:

C - Coagulopathy (e.g., von Willebrand disease, ITP)
O - Ovulatory dysfunction (most common cause; anovulation due to HPO axis imbalance)
E - Endometrial causes
I - Iatrogenic (e.g., oral contraceptives, anticoagulants, tamoxifen)
N - Not otherwise classified
Rosen's Emergency Medicine; Sabiston Textbook of Surgery

Epidemiology

Affects 10-30% of women of reproductive age
~20% of cases occur postmenarchally in adolescents (due to immature HPO axis)
~50% of cases occur perimenopausal (incipient ovarian failure)
~75% of cases have no demonstrable organic cause - most are due to anovulation ("anovulatory/dysfunctional bleeding")
Postmenopausal AUB is a red flag - 90% of endometrial cancers present with postmenopausal bleeding
Goldman-Cecil Medicine

Key Causes by Age Group

Age Group	Most Common Causes
Adolescents	Anovulation (immature HPO axis), coagulopathy (von Willebrand disease)
Reproductive age	OCP complications, pregnancy complications, fibroids, polyps, PCOS, coagulopathy
Perimenopausal	Anovulation, endometrial hyperplasia
Postmenopausal	Atrophy (most common), endometrial cancer, polyps

Key Points

AUB is a symptom, not a diagnosis - always search for the underlying cause
Postmenopausal bleeding is not included in PALM-COEIN and is considered its own diagnosis requiring separate workup
Screening for coagulopathy is indicated when heavy bleeding has been present since menarche
Endometrial biopsy is indicated in women ≥45 years with AUB, or younger with risk factors for endometrial cancer (obesity, anovulation, unopposed estrogen, family history)

Menopause definition

Finding Sources

Reading File

Here is a comprehensive definition of menopause drawn from multiple authoritative textbooks:

Menopause - Definition

Core Definition

Menopause is defined as the permanent cessation of menstruation resulting from loss of ovarian follicular activity. It is the culmination of a process of reproductive aging typically occurring in the fifth to sixth decades of life.

Clinically diagnosed after 12 consecutive months of amenorrhea with no other physiological or pathological cause
Median age: 51-52.5 years in most populations
Premature menopause (Primary Ovarian Insufficiency): menopause before age 40
Goldman-Cecil Medicine; Textbook of Family Medicine 9e; Tietz Textbook of Laboratory Medicine

Pathophysiology

The underlying mechanism is follicular depletion:

Throughout reproductive life, ~400 primordial follicles mature and ovulate; hundreds of thousands undergo atresia
By ~age 45, few primordial follicles remain
Ovaries fail to produce adequate estrogen and inhibins A and B
Without estrogen/progesterone negative feedback, FSH rises markedly (and LH rises moderately) in a futile attempt to stimulate the ovary
Estrogen production falls to near zero; the ovary continues to produce some androgens (testosterone, androstenedione) due to elevated LH
Guyton & Hall Medical Physiology; Ganong's Review of Medical Physiology

Related Terminology

Term	Definition
Perimenopause	The transition period before menopause - can last 2-10 years; FSH rises first, then LH; cycles become irregular
Premenopause	The entire reproductive period before any menopausal changes begin
Postmenopause	All time after the final menstrual period
Premature ovarian insufficiency (POI)	Ovarian failure before age 40 (formerly called premature ovarian failure)

Hormonal Changes

Hormone	Change at Menopause
Estrogen (E2)	Markedly decreased
Progesterone	Decreased
FSH	Markedly increased (most sensitive marker)
LH	Moderately increased
Inhibin A & B	Decreased
Testosterone/Androstenedione	Relatively preserved (produced by ovarian stroma)

Clinical Features (Symptoms of Estrogen Withdrawal)

Vasomotor symptoms - hot flushes/flashes (75% of women; may last up to 40 years), night sweats
Genitourinary atrophy - vaginal dryness, dyspareunia, urinary symptoms
Psychological - irritability, anxiety, fatigue, mood changes
Skeletal - osteoporosis (loss of estrogen's bone-protective effect)
Cardiovascular - increased risk of ischemic heart disease
Hirsutism - in some women, due to decreased estrogen/androgen ratio

Guyton & Hall; Ganong's; Tietz Laboratory Medicine

Factors That Influence Age at Menopause

Earlier menopause: smoking (by 1-2 years), low socioeconomic status, African American/Hispanic ethnicity, shorter menstrual cycles, genetic factors (Fragile X, mosaic Turner syndrome), environmental endocrine disruptors
Later menopause: oral contraceptive use, higher parity, Asian ethnicity
Goldman-Cecil Medicine

Diagnosis

In women >45 years: can be diagnosed clinically based on menstrual history and age alone; lab tests optional
FSH >30-40 IU/L supports the diagnosis if needed
In women <40 years: must rule out other causes before diagnosing POI; further investigation of etiology is warranted

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