What is the structured history used to screen for a coagulopathy (AUB-C) in heavy menstrual bleeding?

A positive screen (identifying ~90% of bleeding disorders) is suggested by heavy menstrual bleeding since menarche PLUS one of: postpartum haemorrhage, surgery-related bleeding, or bleeding with dental work; OR two or more of: bruising 1-2x/month, epistaxis 1-2x/month, frequent gum bleeding, or a family history of bleeding.

Von Willebrand disease is the commonest, found in ~13% of women with HMB.

Clinical relevance. The structured history catches ~90% of bleeding disorders behind HMB, especially von Willebrand disease.

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Screening for coagulopathy (AUB-C)

A structured history efficiently identifies women with an underlying bleeding disorder, who need different management.

The structured screen

A positive screen (about 90% sensitivity for an underlying disorder) is one of:

• Heavy menstrual bleeding since menarche, PLUS
• One of: postpartum haemorrhage, surgery-related bleeding, or bleeding with dental work; OR
• Two or more of: bruising 1-2 times/month, epistaxis 1-2 times/month, frequent gum bleeding, or a family history of bleeding symptoms.

Commonest disorder

Von Willebrand disease is the most common, present in about 13% of women with heavy menstrual bleeding.

If positive

Consult a haematologist and/or test von Willebrand factor and ristocetin cofactor activity.