🤰 Obstetrics & GynaecologyReproductiveStudentInternResident

Abnormal Uterine Bleeding (AUB)

Also known as: AUB · menorrhagia · heavy menstrual bleeding · dysfunctional uterine bleeding

Bleeding abnormal in amount, timing or duration. It is organised by the PALM-COEIN system — structural causes (polyp, adenomyosis, leiomyoma, malignancy) and non-structural (coagulopathy, ovulatory dysfunction, endometrial, iatrogenic, not-yet-classified).

Source · Reviewed 2026-08-15 · v1.0— AI-assisted draft — verify against the cited guideline before clinical use.

⚕️ Education only — not medical advice. Verify against the latest official guideline and your local protocol; confirm every drug dose against the cited source before clinical use.

Who gets it

Any woman of reproductive age; ovulatory dysfunction is common at the extremes (adolescence, perimenopause); consider fibroids, coagulopathy and — importantly — malignancy at older ages.

Red flags — escalate / refer

Haemodynamic instability from heavy bleeding, postmenopausal bleeding (exclude endometrial cancer), or severe anaemia → urgent assessment.

Work-up / diagnosis

1EXCLUDE pregnancy first; check FBC (anaemia) and targeted tests (thyroid, coagulation if suggestive).
2Pelvic examination and ultrasound; endometrial sampling for at-risk/older women or any postmenopausal bleeding.

Management — overview

Resuscitate acute heavy bleeding.
Then treat by cause and the woman's wishes/fertility plans — medical options include tranexamic acid, NSAIDs and hormonal therapy (the levonorgestrel intrauterine system is highly effective; also the combined pill and progestogens).
Treat structural causes (fibroids) specifically; give iron for anaemia; surgery (endometrial ablation, hysterectomy) for refractory cases.

In-depthFull dosing & advanced protocol

Drug dosing

Tranexamic acid ± NSAID (during menses)

Reduce menstrual blood loss

Adult dose: During bleeding days per protocol
Route: Oral

ICMRStandard Treatment Workflows (STWs), India — Dept. of Health Research & ICMR (2022+) ↗

Hormonal (LNG-IUS / COCP / progestogen) + iron

Cycle control / endometrial protection; anaemia

Adult dose: Per protocol
Route: Intrauterine / oral

WHOWHO Model List of Essential Medicines (electronic EML) (2025 (24th)) ↗

Exclude pregnancy and cancer; LNG-IUS first-line

Always exclude pregnancy, and exclude malignancy in older/postmenopausal women.
The levonorgestrel intrauterine system is first-line for heavy menstrual bleeding without a structural cause.
PALM-COEIN organises the differential and the work-up.

ICMRStandard Treatment Workflows (STWs), India — Dept. of Health Research & ICMR (2022+) ↗

References

Guidelines change. If something here is out of date, tell us — we keep these current.

🚩 Report outdated / suggest update

More protocols

Antenatal CareStructured pregnancy care to keep mother and baby healthy — screening, supplementation, immunisation and danger-sign education across scheduled contacts.Pre-eclampsia & EclampsiaPre-eclampsia = new hypertension with proteinuria or organ dysfunction after 20 weeks; eclampsia adds seizures. Magnesium sulfate prevents/treats the seizures and delivery is the definitive cure.Gestational Diabetes (GDM)Glucose intolerance first recognised in pregnancy. Good control reduces macrosomia, birth trauma and neonatal problems; most cases resolve after delivery.

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👤 Who gets it

🚩 Red flags — escalate / refer

🔎 Work-up / diagnosis

🧭 Management — overview

💊 Drug dosing

Tranexamic acid ± NSAID (during menses)

Hormonal (LNG-IUS / COCP / progestogen) + iron

📈 Exclude pregnancy and cancer; LNG-IUS first-line

📚 References

More protocols

👤 Who gets it

🚩 Red flags — escalate / refer

🔎 Work-up / diagnosis

🧭 Management — overview

💊 Drug dosing

Tranexamic acid ± NSAID (during menses)

Hormonal (LNG-IUS / COCP / progestogen) + iron

📈 Exclude pregnancy and cancer; LNG-IUS first-line

📚 References

More protocols

Who gets it

Red flags — escalate / refer

Work-up / diagnosis

Management — overview

Drug dosing

Exclude pregnancy and cancer; LNG-IUS first-line

References

Who gets it

Red flags — escalate / refer

Work-up / diagnosis

Management — overview

Drug dosing

Exclude pregnancy and cancer; LNG-IUS first-line

References