Abnormal uterine bleeding (the old dysfunctional uterine bleeding): How to manage?

Dysfunctional uterine bleeding (DUB) could be subclassified as ovulatory or anovulatory, reflecting either true endometrial dysfunction or perturbation of the hypothalamic–pituitary–ovarian (HPO) axis, but was typically seen as a diagnosis of exclusion. The PALM COEIN classification encourages a structured approach to assessment to ensure no potential contributors to the menstrual bleeding complaint are overlooked. Those women with AUB with a structurally normal uterus and absence of iatrogenic cause should be reclassified under the abnormal uterine bleeding (AUB) subcategories of coagulopathy (AUB-C), ovulatory (AUB-O), and endometrial (AUB-E) origin. Careful history, examination, and targeted investigations are critical to ensure appropriate diagnosis and subsequent treatment options. Management options should be patient centered and encompass the contraceptive and fertility needs of each woman. However, hysterectomy, while definitive, continues to have the potential for serious complications.