ACOG releases guidelines on management of abnormal uterine bleeding associated with ovulatory dysfunction.

Abnormal uterine bleeding related to ovulatory dysfunction (i.e., oligo-ovulation and anovulation) is a range of disorders often associated with heavy, irregular bleeding. Assessment includes a medical history, physical examination, and selected laboratory and imaging tests (i.e., pregnancy test; beta subunit of human chorionic gonadotropin test; measurement of thyroid-stimulating hormone and prolactin levels; endometrial biopsy; and saline infusion sonohysterography, hysteroscopy, or transvaginal ultrasonography). Causes of anovulation, which should be considered during the evaluation, include adolescence, perimenopause, lactation, pregnancy, hyperandrogenic conditions, hypothalamic dysfunction, hyperprolactinemia, thyroid disease, primary pituitary disease, premature ovarian failure, iatrogenic, and medications. The American College of Obstetricians and Gynecologists (ACOG) treatment recommendations are based on the assumption that a physician has confirmed the diagnosis, as well as ruled out endometrial and structural pathologies. A classification system called the PALM-COEIN was developed to describe uterine bleeding abnormalities in women of reproductive age. It includes the structural causes (polyp, adenomyosis, leiomyoma [submucosal or other myoma], and malignancy and hyperplasia) and nonstructural causes (coagulopathy, ovulatory dysfunction, endometrial, iatrogenic, and not yet classified). Each potential cause is linked with at least one letter qualifier specifying its etiologies.