Compare conditions

Put any two — or three — conditions side by side, adult or pediatric, to spot the look-alike differences fast, row by row.

AUB · Abnormal Uterine Bleeding

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In one line

·Abnormal uterine bleeding (periods that are too heavy, too long, too often, or happen at the wrong time) happens when something breaks the normal hormone cycle, a growth forms in the uterus, blood clotting fails, or cancer develops.

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Normal physiology

·In a normal cycle, estrogen rises during the first half and builds the endometrium (the lining inside the uterus). Around day 14, your ovary releases an egg (ovulation), and the empty follicle (corpus luteum) starts making progesterone. Progesterone stabilizes the lining and prepares it for a fertilized egg. If no pregnancy happens, both hormones drop and the lining sheds neatly—that is your period.

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What goes wrong

·One upstream break—a hormone imbalance, a growth, a clotting problem, or cancer—explains why bleeding becomes heavy, long, or random.

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Hallmark signs

·Heavy menstrual bleeding (soaking through one or more pads or tampons every hour, passing clots bigger than a quarter, or losing more than 80 mL per cycle)
·Prolonged menstrual bleeding (periods lasting more than 7 days)
·Intermenstrual bleeding (bleeding between periods)
·Fatigue and weakness
·Shortness of breath with activity (dyspnea on exertion)
·Pale skin and mucous membranes (pallor, especially inside eyelids and under nails)
·Fast heart rate (tachycardia, often above 100 beats per minute at rest)
·Dizziness, lightheadedness, or fainting (syncope)

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Red flags · escalate now

·Fainting, severe dizziness, or blood pressure below 90/60 mmHg — means sudden heavy bleeding has dropped your blood volume so low that your body is going into shock (hypovolemic shock). You need IV fluids, possibly a blood transfusion, and hospital admission right away.
·Any vaginal bleeding more than 12 months after your last period (postmenopausal bleeding) — endometrial cancer until proven otherwise. Requires urgent endometrial biopsy or transvaginal ultrasound within days.
·Hemoglobin below 7 g/dL or severe anemia symptoms (chest pain, shortness of breath at rest, confusion) — your oxygen delivery is dangerously low. Requires blood transfusion and hospital admission.
·Positive pregnancy test with abnormal bleeding — ectopic pregnancy (pregnancy growing outside the uterus, often in a tube) or miscarriage must be ruled out immediately with a blood test (quantitative β-hCG) and ultrasound. An ectopic can rupture and cause life-threatening internal bleeding.
·Bleeding that will not stop despite medicine, or signs your circulation is failing (cold skin, rapid weak pulse, confusion) — may need an emergency procedure: D&C (scraping the lining out), uterine artery embolization (blocking the vessels that feed the uterus), or hysterectomy (removing the uterus).

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Workup

·Complete blood count (CBC) with red blood cell indices
·Serum ferritin
·Thyroid-stimulating hormone (TSH)
·Prothrombin time (PT), activated partial thromboplastin time (aPTT), and von Willebrand panel (if heavy bleeding started at the very first period, or if bleeding disorders run in the family, or if there is easy bruising or nosebleeds)
·Transvaginal or pelvic ultrasound
·Endometrial biopsy
·Saline infusion sonohysterography or hysteroscopy (if the first ultrasound suggests something abnormal inside the uterus)
·Pregnancy test (quantitative serum beta-hCG if the urine test is unclear or if ectopic pregnancy is suspected)

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Treatment

·Acute management for life-threatening bleeding: intravenous fluids, packed red blood cell transfusion if hemoglobin is below 7 g/dL or if the patient has severe symptoms (chest pain, shortness of breath, confusion, severe dizziness) at any hemoglobin level, high-dose intravenous conjugated estrogen (25 mg IV every 4 to 6 hours for up to 24 hours), or intravenous tranexamic acid (10 mg per kilogram, up to 1 gram, every 6 to 8 hours).
·First-line hormonal therapy for non-acute abnormal uterine bleeding: combined oral contraceptive pills (contain both estrogen and progestin, taken daily), progestin-only pills (medroxyprogesterone acetate 10 mg daily for 10 to 14 days each month, or norethindrone 5 mg daily), or a levonorgestrel-releasing intrauterine device (LNG-IUD, a small T-shaped device placed inside the uterus that releases progestin locally).
·Tranexamic acid (oral, 1300 mg three times daily during menstruation only, for a maximum of five days per cycle) for women who ovulate regularly but have heavy menstrual bleeding and a normal uterus on imaging.
·Nonsteroidal anti-inflammatory drugs (NSAIDs): ibuprofen 600 to 800 mg three times daily, or naproxen 500 mg twice daily, taken during menstruation only.
·Surgical management: hysteroscopic resection of polyps or submucosal fibroids (fibroids that bulge into the uterine cavity), endometrial ablation (destroying the lining of the uterus using heat, cold, or radiofrequency energy), or hysterectomy (removing the uterus completely through the vagina or through small cuts in the belly).
·Iron supplementation: oral ferrous sulfate 325 mg (containing 65 mg of elemental iron) once or twice daily, or intravenous iron (such as iron sucrose or ferric carboxymaltose) if oral iron upsets the stomach or is not absorbed well.
·Packed red blood cell transfusion if hemoglobin is below 7 g/dL, or if the patient has severe symptoms (chest pain, shortness of breath, confusion, severe dizziness, or signs of heart strain on ECG) at any hemoglobin level.

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NCLEX trap

·Heavy period bleeding (doctors call it AUB, abnormal uterine bleeding) has real numbers: losing more than 80 mL of blood each cycle. That means soaking through a pad or tampon in less than 2 hours, passing clots bigger than a quarter, or bleeding lasting over 7 days, or cycles coming faster than every 21 days or slower than every 35 days. Even if the woman looks calm, you must measure the bleeding by asking specific questions: How many pads do you soak all the way through in a day? How big are the clots? Do a pelvic exam (gloved fingers inside and pressing on the belly to feel the uterus and ovaries). Order a pelvic ultrasound and check blood tests — complete blood count to see if she is anemic (not enough red blood cells to carry oxygen), pregnancy test, and thyroid hormone. Stress does NOT cause heavy period bleeding. The real causes are: not releasing an egg each month (anovulation, like a factory skipping a step), benign muscle tumors in the uterus (fibroids, like rubber balls growing in the wall), growths in the lining (polyps, like mushrooms on a log), uterine lining tissue growing into the muscle wall (adenomyosis, like tree roots pushing into concrete), bleeding disorders in the blood itself (coagulopathy, when blood cannot clot normally), and cancer.
·Always do a urine or blood pregnancy test first. Pregnancy outside the uterus (ectopic pregnancy, like a seed trying to grow in a narrow pipe instead of good soil) and miscarriage both cause heavy bleeding and can kill the patient. Always ask: Do you bruise easily? Do you get nosebleeds often? Does anyone in your family have a bleeding disorder (like von Willebrand disease, when blood cannot stick together into clots, or low platelets, the tiny sticky cells that plug holes in blood vessels)? Always take a tiny sample of the uterine lining (endometrial biopsy, like taking a small piece of wallpaper to check for mold) in women 45 years or older with heavy periods, or in younger women who have risk factors for uterine cancer. Risk factors are obesity, polycystic ovary syndrome (ovaries with many small cysts and no regular ovulation), diabetes, taking estrogen without progesterone to balance it, or Lynch syndrome (an inherited cancer risk). Find the specific cause first, then treat that cause.
·In sudden, severe heavy bleeding with the body struggling to keep up — heart rate over 110, blood pressure dropping when standing, hemoglobin under 7 g/dL (which means not enough red blood cells to carry oxygen) — stabilize the patient first. Give IV fluids through a large vein. Give packed red blood cells (concentrated red cells in a bag) if hemoglobin is under 7 or the patient feels dizzy and weak. Give medicine to stop the bleeding fast: high-dose IV estrogen (25 mg through the vein every 4 to 6 hours for up to 24 hours) or tranexamic acid (1 gram through the vein or by mouth every 6 to 8 hours; this medicine helps blood clot faster, like adding cement to a leaky wall). Giving iron pills is useless if the uterine lining keeps bleeding out blood faster than the bone marrow can make new red blood cells. Stop the bleeding first, then replace the iron stores.
·Surgery is the last choice unless cancer or severe structural damage requires it. Start with medicine: birth control pills with estrogen and progesterone together, progesterone pills or shots given in a pattern or continuously, a small device placed in the uterus that releases progesterone hormone (levonorgestrel IUD, 52 mg total, releasing 20 micrograms daily; it reduces bleeding by 90% after 12 months by making the lining very thin), tranexamic acid pills (1 gram by mouth three times daily during the period, reduces bleeding by 40 to 50%), or anti-inflammatory pills (mefenamic acid 500 mg three times daily during the period, reduces flow by 25 to 35%). Only do hysterectomy (removing the uterus completely) if medicine fails or the patient cannot tolerate it and she does not want more children, or if cancer is confirmed. Only do endometrial ablation (destroying the lining permanently) if she refuses hysterectomy and does not want more children; ablation destroys fertility forever.
·In heavy period bleeding, exact numbers drive diagnosis and tell you if treatment is working. Ask: How many pads or tampons do you soak all the way through in 24 hours? Do you soak through in less than 2 hours? How many days does bleeding last? Are clots bigger than a quarter? Do you pass chunks of tissue? Have you ever needed a blood transfusion? These numbers prove the bleeding meets the definition of heavy and show whether the treatment you give is working.

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