Abnormal uterine bleeding after pelvic pathology has been excluded.
Cases can be divided into anovulatory or ovulatory.
The majority of patients will report heavy bleeding which may be regular or irregular. It is extremely difficult to make an accurate assessment of the amount of bleeding by relying on history alone. Quantitative measurement of blood loss can be made by collecting all the tampons and sanitary pads and using the alkaline haematin test. On abdominal and pelvic examination there should be no abnormalities detected.
To exclude pelvic pathology, a through pelvic assessment must be made including cervical smear and endometrial biopsy if indicates ultrasound, laparoscopy, hysteroscopy or colour Dopper studies are investigation that may be used depending on the clinical situation.
Anovulatory. In adolescents the oral contraceptive pill will make the withdrawal bleeds lighter, regular and less painful. In the perimenopausal woman, hormone replacement therapy or cyclical progestagens (after exclusion of uterine pathology) would be appropriate.
Ovulatory. Non-steroidal anti-inflammatory drugs, the oral contraceptive pill, Danazol and Antifibrinolytic drugs or the progesterone releasing intrauterine system (IUS) are the main options. Hysterectomy or endometrial resection/ablation are used if the above measures fail.