Diagnosis of Abnormal Uterine Bleeding in Reproductive-Aged Women

Publication Date: July 2, 2012
Last Updated: March 14, 2022

Recommendations and Conclusions

The following recommendations and conclusions are based on good and consistent scientific evidence.

  • Substantial evidence exists to indicate that sonohysterography is superior to transvaginal ultrasonography in the detection of intracavitary lesions, such as polyps and submucosal leiomyomas.
  • In all adolescents with heavy menstrual bleeding and adult patients with a positive screening history for a bleeding disorder, laboratory testing is indicated. Initial tests should include a CBC with platelets, prothrombin time, and partial thromboplastin time (fibrinogen or thrombin time are optional); bleeding time is neither sensitive nor specific and is not indicated.
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The following recommendations and conclusions are based on limited or inconsistent scientific evidence.

  • Testing for Chlamydia trachomatis should be considered, especially in patients at high risk of infection.
  • Hypothyroidism and hyperthyroidism are associated with AUB. Screening for thyroid disease with TSH level measurement in women with AUB is reasonable and inexpensive.

The following recommendations and conclusions are based primarily on consensus and expert opinion.

  • Endometrial tissue sampling should be performed in patients with AUB who are older than 45 years as a first-line test.
  • The American College of Obstetricians and Gynecologists supports the adoption of the PALM–COEIN nomenclature system developed by FIGO to stan- dardize the terminology used to describe AUB.
  • Some experts recommend transvaginal ultrasonography as the initial screening test for AUB and MRI as a second-line test to be used when the diagnosis is inconclusive, when further delineation would affect patient management, or when coexisting uterine myomas are suspected.
  • MRI may be useful to guide the treatment of myomas, particularly when the uterus is enlarged, contains multiple myomas, or precise myoma mapping is of clinical importance. However, the benefits and costs to the patient must be weighed when considering its use.
  • Persistent bleeding with a previous benign pathology, such as proliferative endometrium, requires further testing to rule out nonfocal endometrial pathology or a structural pathology, such as a polyp or leiomyoma.

Recommendation Grading




Diagnosis of Abnormal Uterine Bleeding in Reproductive-Aged Women

Authoring Organization

Publication Month/Year

July 2, 2012

Last Updated Month/Year

April 5, 2023

Document Type


External Publication Status


Country of Publication


Inclusion Criteria

Female, Adult

Health Care Settings


Intended Users

Physician, nurse nurse midwife, nurse certified nurse midwife, nurse, nurse practitioner, physician assistant



Diseases/Conditions (MeSH)

D014591 - Uterine Diseases


abnormal uterine bleeding, uterine bleeding, AUB