Surreal lotus flower representing women's reproductive health and primary care for abnormal uterine bleeding.

Decoding Abnormal Uterine Bleeding: A Woman's Guide to Understanding and Managing AUB

Elliot Brynn in Health & Wellness August 2025 • 3 min read.

"Empowering women to take control of their health by understanding abnormal uterine bleeding (AUB) and exploring primary care solutions."

Abnormal uterine bleeding (AUB) is a common concern for women, affecting up to 25% of reproductive-age individuals. It can disrupt daily life, impact emotional well-being, and raise questions about overall health. Fortunately, understanding AUB and exploring available management options can empower women to take control of their health journey.

Traditionally, AUB often leads to referrals to specialists and hospital visits. However, recent research suggests that many cases can be effectively managed within primary care settings. This shift towards primary care management offers potential benefits such as increased accessibility, reduced costs, and a more patient-centered approach.

This article will guide you through the essentials of AUB, including its causes, diagnosis, and the exciting possibilities of primary care management. We'll explore how primary care endometrial sampling (PCES) can play a crucial role in this approach, offering a safe and cost-effective alternative to traditional hospital referrals.

Understanding Abnormal Uterine Bleeding (AUB)

Surreal lotus flower representing women's reproductive health and primary care for abnormal uterine bleeding.

AUB isn't just about heavy periods. It's a broader term encompassing any irregularity in menstrual bleeding, including changes in volume, frequency, or timing. This could manifest as heavier-than-usual flow, prolonged periods, bleeding between periods (intermenstrual bleeding), or bleeding after intercourse (postcoital bleeding). Recognizing these patterns is the first step towards seeking appropriate care.

The causes of AUB are diverse, ranging from hormonal imbalances to structural abnormalities in the uterus. The handy acronym PALM-COEIN helps classify these causes:

Polyps: Growths in the uterine lining.
Adenomyosis: When the uterine lining grows into the muscular wall of the uterus.
Leiomyoma/Fibroids: Non-cancerous tumors in the uterus.
Coagulopathy: Bleeding disorders.

While AUB can be unsettling, it's important to remember that many causes are benign and treatable. However, it's crucial to rule out more serious conditions like atypical hyperplasia or, rarely, cancer. This is where diagnostic tools like endometrial sampling come into play.

Empowering Women Through Primary Care

Primary care endometrial sampling (PCES) offers a promising avenue for managing AUB effectively and conveniently. By making endometrial sampling accessible within primary care settings, women can benefit from earlier diagnosis, reduced referrals to specialists, and a more streamlined healthcare experience. Further research and implementation of PCES programs hold the key to empowering women to take control of their menstrual health and overall well-being.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1136/jfprhc-2017-101735, Alternate LINK

Title: Primary Care Endometrial Sampling For Abnormal Uterine Bleeding: A Pilot Study

Subject: Obstetrics and Gynecology

Journal: Journal of Family Planning and Reproductive Health Care

Publisher: BMJ

Authors: Jon M Dickson, Brigitte Delaney, Mary E Connor

Published: 2017-08-19

Everything You Need To Know

What exactly is considered Abnormal Uterine Bleeding (AUB)?

Abnormal Uterine Bleeding (AUB) is any irregularity in menstrual bleeding. This includes changes in volume, frequency, or timing. For example, heavier-than-usual flow, prolonged periods, bleeding between periods (intermenstrual bleeding), or bleeding after intercourse (postcoital bleeding) are all considered AUB.

What does the acronym PALM-COEIN stand for in the context of Abnormal Uterine Bleeding (AUB)?

The PALM-COEIN classification system is used to identify the various causes of AUB: Polyps (growths in the uterine lining), Adenomyosis (when the uterine lining grows into the muscular wall of the uterus), Leiomyoma/Fibroids (non-cancerous tumors in the uterus), Coagulopathy (bleeding disorders), Endometrial (related to the uterine lining), Ovarian dysfunction, Iatrogenic (related to medical treatment), and Not yet classified.

What is Primary Care Endometrial Sampling (PCES) and what is its role in managing AUB?

Primary care endometrial sampling (PCES) is a procedure where a sample of the uterine lining is taken in a primary care setting for examination. This allows for earlier diagnosis of conditions causing AUB, reduces the need for referrals to specialists, and offers a more streamlined healthcare experience. PCES can help in ruling out serious conditions like atypical hyperplasia or cancer.

What are the advantages of managing Abnormal Uterine Bleeding (AUB) within primary care settings?

The shift towards primary care management of AUB, facilitated by procedures like primary care endometrial sampling (PCES), can increase accessibility to care, reduce costs associated with specialist referrals and hospital visits, and offer a more patient-centered approach. It allows women to benefit from earlier diagnosis and a more convenient healthcare experience.

Besides common causes of Abnormal Uterine Bleeding (AUB) such as fibroids or hormonal imbalances, what other, more serious conditions should be considered?

While hormonal imbalances, structural abnormalities, polyps, adenomyosis, leiomyoma/fibroids, and coagulopathy are common causes, atypical hyperplasia and, in rare cases, cancer can also cause AUB. Diagnostic tools like primary care endometrial sampling (PCES) are used to rule out these more serious conditions. Early diagnosis and appropriate management are crucial for addressing these potential underlying issues and safeguarding women's health.