Considered for women over 45 years, those with hereditary non-polyposis colorectal cancer syndrome, and for persistent AUB that is unexplained or not adequately treated
Variable number of lesions in a given uterus require that they be afforded a separate categorization system
Asymptomatic and frequently not the cause of AUB
Primary classification system reflects only the presence or absence of 1 or more leiomyomas
Secondary system requires the clinician to distinguish leiomyomas involving the endometrial cavity (submucosal) because it is considered that submucosal lesions are the most likely to contribute to the genesis of AUB
Clinical Screening for an Underlying Disorder of Hemostasis in the Patient With Excessive Menstrual Bleeding
Initial screening should be structured by the medical history
A positive screening result comprises heavy menstrual bleeding plus one of the following: postpartum hemorrhage, surgery-related bleeding, bleeding associated with dental work, or two or more of the following: bruising 1-2x per month, epistaxis 1-2x per month, frequent gum bleeding, family history of bleeding symptoms
Patients with a positive screening result should be considered for further evaluation, including consultation with a hematologist and testing for von Willebrand factor and ristocetin cofactor
Menstrual bleeding stops if prostaglandins cause contractions and expulsion, or if endometrial healing and cessation of bleeding occurs with increasing estrogen