Uterine bleeding that is abnormal in timing, duration, or quantity affects nearly one-third of women and carries a substantial financial and quality-of-life burden. An estimated 5% of ED visits are for vaginal bleeding, and 1% of those patients will have a life-threatening cause that must be identified.
Emergency clinicians need to have a comprehensive understanding of the pathophysiology and etiologies of abnormal uterine bleeding to manage and treat these patients.
Our recent issue Emergency Department Management of Abnormal Uterine Bleeding in the Nonpregnant Patient reviews the most recent updates on common causes and the approach to abnormal uterine bleeding in the nonpregnant patient, including vaginal bleeding in prepubescent females.
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Here are a few key points:
- Abnormal uterine bleeding (AUB) affects approximately one-third of women at some time in their life.
- Duration of menstrual bleeding >7 days and blood loss >80 mL are considered abnormal.
- The PALM-COEIN classification system can help distinguish the cause of bleeding.
- PALM refers to structural causes: polyp, adenomyosis, leiomyoma, malignancy/hyperplasia.