Abnormal (Dysfunctional) Uterine Bleeding Clinical Presentation

Updated: Dec 07, 2018
  • Author: Millie A Behera, MD; Chief Editor: Richard Scott Lucidi, MD, FACOG  more...
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Suspect abnormal uterine bleeding (AUB) when a patient presents with unpredictable or episodic heavy or light bleeding despite a normal pelvic examination.

Note the following:

  • Typically, the usual moliminal symptoms that accompany ovulatory cycles will not precede bleeding episodes.

  • Exclude the diagnosis of pregnancy first.

  • Address the presence of local and systemic disease. Rule out the presence of signs or symptoms indicative of bleeding disorders. Screening for personal and family history of easy bruising, bleeding gums, epistaxis, and excessive bleeding episodes during childbirth, surgery, or dental procedures may be useful.

  • Rule out iatrogenic causes of bleeding, including bleeding secondary to steroid hormone contraception, hormone replacement therapy, or other hormone treatments, which are common causes.

  • Most patients are adolescents or are older than 40 years.

Patients who report irregular menses since menarche may have polycystic ovarian syndrome (PCOS). [5] PCOS is characterized by anovulation or oligo-ovulation and hyperandrogenism. These patients often present with unpredictable cycles and/or infertility, hirsutism with or without hyperinsulinemia, and obesity. A retrospective study by Maslyanskaya et al identified 125 female patients, 8-20 years of age, who were admitted for treatment of abnormal uterine bleeding and reported that PCOS accounted for 33% of admissions and was the most common underlying etiology. Other underlying causes were hypothalamic pituitary ovarian axis immaturity (31%); endometritis (13%); and bleeding disorders (10%). [6]


Patients with adrenal enzyme defects, hyperprolactinemia, thyroid disease, or other metabolic disorders also might present with anovulatory bleeding.



The physical examination can elicit several anatomic and organic causes of abnormal uterine bleeding (AUB).

A complete physical examination should begin with assessment of hemodynamic stability (vital signs) and proceed with evaluation of the following:

  • Obesity (BMI)

  • Signs of androgen excess (hirsutism, acne)

  • Thyroid enlargement or manifestations of hyperthyroidism or hypothyroidism.

  • Galactorrhea (may suggest hyperprolactinemia)

  • Visual field deficits (raise suspicion of intracranial/pituitary lesion)

  • Ecchymosis, purpura (signs of bleeding disorder)

  • Signs of anemia or chronic blood loss

  • A careful gynecologic examination, including Papanicolaou test (Pap smear) and sexually transmitted disease (STD) screening, is warranted.

  • The hallmark of AUB is a negative pelvic examination despite the clinical history. In such cases, management might rest on a clinical diagnosis. Rule out the presence of uterine fibroids or polyps, as well as rule out endometrial hyperplasia or carcinoma.