Abnormal Uterine Bleeding

One-third of women experience abnormal uterine bleeding (AUB) in their lifetimes. AUB is bleeding from the uterus that is irregular, is more than normal, happens more frequently than normal, or lasts longer than normal in women who are not pregnant. Causes of AUB can be either structural or nonstructural. Nonstructural causes, such as blood coagulation disorders and dysfunction of the ovaries, cannot be diagnosed with imaging.

Structural causes include fibroids (noncancerous growths), adenomyosis (endometrial tissue growing into the uterine muscle wall), and cancer in the uterus (endometrial or myometrial). Structural cause can be evaluated with imaging.

To evaluate AUB, the doctor performs an assessment including taking a woman’s history, performing a physical examination, and ordering laboratory and imaging tests.
Duplex Doppler ultrasound of the pelvis (an ultrasound technique that evaluates blood flow), transabdominal ultrasound, or transvaginal ultrasound (from inside the vagina) is usually appropriate as the first imaging test. These tests are complementary and are often done together.

If initial imaging tests are not conclusive or the findings need further evaluation, ultrasound sonohysterography (ultrasound after injecting fluid into the uterus to better define the inside of the uterus) or pelvic MRI with and without intravenous contrast is usually appropriate.

After initial imaging tests, if surveillance is recommended, Doppler ultrasound of the pelvis, transabdominal ultrasound, transvaginal ultrasound, ultrasound sonohysterography, and pelvic MRI with and without intravenous contrast are usually appropriate. These tests are complementary and are often done together.

For more information, see the Abnormal Vaginal Bleeding page.

— By Samantha Greben, BA and Ryan K. Lee, MD, MBA. This information originally appeared in the Journal of the American College of Radiology.