Abnormal Uterine Bleeding
Abnormal uterine bleeding (AUB) is defined as bleeding from the nonpregnant uterus occurring outside the parameters of normal menstruation. AUB accounts for approximately 30% of all gynecology visits. Classification systems have been developed to organize the multiple etiologies of what appears to be AUB. The most common classification system uses the PALM-COEIN acronym to categorize the most common etiologies as either structural or nonstructural. In this chapter, we present an alternative, more comprehensive classification system for abnormal vaginal bleeding using the SPIN acronym that includes systemic, pregnancy, infection, neoplastic etiologies subcategorized according to anatomic locations. After reviewing the various AUB etiologies, the chapter describes a straightforward, stepwise approach for evaluating patients with apparent AUB. The chapter also describes acute and chronic treatment approaches for anovulatory bleeding, the single most common cause of AUB. Finally, the chapter reviews the various treatment approaches for the most common systemic and anatomic etiologies of AUB.
