Illness script
Abnormal Uterine Bleeding (AUB)
Reproductive-age woman with heavy, prolonged, or irregular menstrual bleeding outside normal patterns.
This illness script for Abnormal Uterine Bleeding (AUB) covers the classic presentation, who it affects, how you work it up, the mechanism, and first-line treatment—written for USMLE Step 1 and clerkship clinical reasoning.
Updated Jul 18, 2026All scripts
01
Who it affects
- Reproductive-age women; peaks at menarche and perimenopause
- Anovulatory bleeding common at extremes of age
- Risk factors: obesity, PCOS, thyroid disease, coagulopathy
- Fibroids/polyps more common with age
- Any postmenopausal bleeding = cancer until proven otherwise
02
Diagnostics & workup
- History: quantify bleeding, cycle length, sexual/contraceptive history
- Always exclude pregnancy first: urine/serum hCG
- CBC (anemia), TSH, prolactin, coagulation studies if indicated
- Pelvic exam and Pap; STI testing as appropriate
- Transvaginal ultrasound: assess endometrial thickness, fibroids, polyps
- Endometrial biopsy if >45 yo, risk factors, or postmenopausal bleeding
03
Pathophysiology
- Ovulatory: structural lesions (fibroids, polyps, adenomyosis) or coagulopathy
- Anovulatory: unopposed estrogen without progesterone withdrawal
- Erratic endometrial proliferation leads to unstable shedding
- PALM-COEIN framework classifies structural vs non-structural causes
- Chronic anovulation risks endometrial hyperplasia/carcinoma
04
Treatment
- Hemodynamically unstable/acute: IV high-dose estrogen, consider D&C
- Medical first-line: combined OCPs or progestins
- Levonorgestrel IUD highly effective for heavy bleeding
- Tranexamic acid or NSAIDs to reduce menstrual flow
- Treat underlying cause: thyroid, PCOS, coagulopathy
- Surgical: hysteroscopic polyp/fibroid removal, ablation, or hysterectomy if refractory
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Full libraryEducational use only. This illness script is a study framework, not medical advice. Confirm decisions with current guidelines and your clinical supervisors.