Management of abnormal uterine bleeding

Female presenting to a peripheral unit with AUB

History, General examination, vaginal examination

Females in post menarcheal age Reproductive age group Post menopausal age
group group

Look for pregnancy and pregnancy related <40 years >40 years
complications with ultrasound if possible
E.g. ectopic pregnancy, hydatifoam mole,
miscarriage, bleeding diathesis
Look for other Look for other
causes* causes*
No Referral for
Yes endometrial
evaluation
Yes No Look
Yes for other No
Reassurance causes

Refer to Refer to Medical Refer to Referral for

If continues to bleed
tertiary care tertiary care management tertiary care endometrial
nor-ethiresterone
center centre centre evaluation
5mg 8 hourly for 21
days

Female presenting at a tertiary care centre with AUB

History, General Examination, Vaginal Examination

Females in post menarcheal age Reproductive age group Post menopausal age
group group

Look for pregnancy and pregnancy related <40 years >40 years
complications with ultrasound if possible
E.g. ectopic pregnancy, hydatifoam mole,
miscarriage, bleeding diathesis

Look for other Look for other

causes* causes*

Yes No
Yes No Yes No
Endometrial
evaluation
Reassurance Medical Medical Medical +/- Endometrial
Medical +/- +/- surgical management with surgical evaluation with
surgical manageme tanexamic acid management hysteroscopy
management nt mefenamic acid, and biopsy
nor-ethiresterone TVS, D&C
If continue to bleed
Northiresterone
5mg 8 hourly for
21 days Surgical management with
(If no response) hysteroscopy if required

Differential diagnosis for Abnormal uterine bleeding* Sri Lanka College of Obstetrics and
Genital tract pathologies Gynaecology
Systemic conditions Health sector development Project

Trauma Documentation in all steps is Guidelines- Management of breech

presentation
Medication and iatrogenic causes Mandatory
(See Guideline on AUB-section 4)