Evaluation and Management of

Abnormal Uterine Bleeding in

Premenopausal Women

MARY GAYLE SWEET, MD; TARIN A. SCHMIDT-DALTON, MD; and

PATRICE M. WEISS, MD Virginia Tech Carilion School of Medicine and
Research Institute, Roanoke, Virginia
KEITH P. MADSEN, MD, Joint Base McGuire-Dix-Lakehurst, New Jersey

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PENDAHULUAN
• Insidensi hampir > 14 % wanita pre menopause
mengalami abnormal uterine bleeding

• Perdarahan tersebut dapat bersifat ovulatoar dan

anovulatoar

• Memiliki resiko terjadinya Ca endometrium

• Faktor resiko : PCO, Uncontroled DM, hiperprolaktinemia,

thyroid desease, dan obat-obat psikotik

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OVULATOAR BLEEDING AND
UNOVULATOAR BLEEDING

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OVULATOAR UNOVULATOAR
Intervalnya reguler (setiap 24 - • Irregular  Lebih sering
35 hari) dengan perdarahan unfrequent

excessive atau perdarahan
dengan durasi ≥ 7 hari
< 1 % berkembang menjadi
kanker atau hiperplasia (asalkan • Perdarahan dari minimal sd
tidak ada factor resiko
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• Karena defisiensi
Progesterone atau dominasi
estrogen
berat
• 14 % perempuan dengan
siklus unovulatoar berulang 
berkembang menjadi kanker
dan hiperplasia

4
Amenorrhea, Oligomenorrhoe, Metrorraghia
 ABNORMAL VAGINAL BLEEDING
Ovulatory = Regular Anovulatory = Irregular or no
Menorrhagia bleeding
Hypomenorrhea Metrorrhagia/ MMR
Polymenorrhea Oligomenorrhea
IMB Amenorrhea
PCB Post-menopausal

• Abnormal timing of bleeding: IRREGULAR Cycles

– Metrorrhagia
• Light “irregularly irregular” bleeding
– Menometrorrhagia
• Heavy “irregularly irregular” bleeding

– Post-menopausal: bleeding >1 year after menopause

 Decreased frequency of bleeding
◦ Oligomenorrhea
 No bleeding 36 days- 3 months
◦ Amenorrhea
 No bleeding for…
 3 cycle intervals or
 6 months (in oligomenorrheic women)
 Anovulatory Bleeding

>> mengikuti periode

menarche, karena prematur
controle dari hypothalamic-
pituitary-ovarian axis (1-3 >> terjadi 8 thn menjelang
thn pertama) menopause

• ovulation does not

2 • leading to 4
occur prolonged
• no corpus luteum
estrogenic
forms to produce • excessive
stimulation of the
progesterone proliferation
endometrium

1 3
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 hyperplasia with Ca
14 % perempuan
atypia endometrial

Recurrent
anovulatory Risk Factor
cycles

Anovulatoar bleeding -->> terjadi 8 thn menjelang

menopause
20% dari Ca endometrial didiagnosis saat
premenopausal
Risk Factor : advanced age, obesity, nulliparity, infertility, diabetes, family
history of colon cancer, long-term unopposed estrogen therapy, or a history of
tamoxifen use

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Adolescent or woman < 35 years with no
risks of endometrial cancer4

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 Adolescent or woman < 35 years with
recurrent anovulation and/or other risks
of endometrial cancer

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 Evaluation and Treatment of Anovulatory Abnormal
Uterine Bleeding
Woman ≥ 35 years with suspected
anovulation

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 Evaluation and Treatment of Anovulatory Abnormal Uterine
Bleeding

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 Evaluation and Treatment of Anovulatory Abnormal Uterine
Bleeding

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TREATMENT

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TREATMENT

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