Abnormal Uterine Bleeding: Diagnostic and Therapeutic Approach

Abnormal uterine bleeding is a frequent gynecological condition with a significant impact on women’s health across the lifespan. It arises from complex alterations in normal menstrual physiology, including hormonal imbalance, impaired endometrial hemostasis, abnormal angiogenesis, and structural uterine pathology. Under physiological conditions, coordinated fluctuations of estrogen and progesterone regulate endometrial proliferation, differentiation, and shedding, while effective hemostatic mechanisms limit menstrual blood loss. Disruption of these processes leads to excessive, irregular, or prolonged bleeding. Clinically, abnormal uterine bleeding may present as acute or chronic disease, a distinction that guides diagnostic urgency and therapeutic decision-making. Its etiology varies according to age, with ovulatory dysfunction predominating in adolescents and younger women, and structural causes such as polyps, fibroids, and adenomyosis becoming more prevalent during the perimenopausal period. Postmenopausal bleeding warrants particular attention because of its association with endometrial malignancy. The FIGO PALM–COEIN classification system provides a standardized framework to distinguish structural from non-structural causes and supports a systematic diagnostic approach. Evaluation of abnormal uterine bleeding relies on detailed clinical history, characterization of bleeding patterns, physical and gynecological examination, and identification of red flags suggestive of malignancy. Diagnostic assessment integrates laboratory testing to exclude anemia and systemic disorders, imagingprimarily transvaginal ultrasoundto identify structural abnormalities, and endometrial sampling in patients at increased risk for endometrial pathology. Management is individualized and stepwise, prioritizing medical therapy with non-hormonal or hormonal options based on etiology, symptom severity, and reproductive goals. Surgical and interventional treatments are reserved for refractory cases or severe bleeding. Special populations, including adolescents, perimenopausal women, and patients with bleeding disorders or on anticoagulation therapy, require tailored strategies and close follow-up.