Borders Ref Help Toolkit
Who to refer and who not refer:
Please refer to diagram above.
How to refer:
Via SCI gateway as indicated in diagram above
Abnormal bleeding
Warning
Normal Menstrual Cycle
A “normal” menstrual cycle is defined based on 4 parameters (frequency, regularity, duration, or volume) summarised the table below:
| Parameter Normal Limits | (5th to 95th centile) |
| Frequency of menses (days) | 24 to 38 days |
| Regularity (Cycle length) | ≤7 to 9 days |
| Duration (days of bleeding in a single menstrual period) | ≤8 days |
| Volume (monthly blood loss) | Clinical definition is subjective and defined as a volume of menstrual blood loss that does not interfere with a woman’s physical, social, emotional, and/or quality of life |
Abnormal Uterine Bleeding
This is the overarching term used to describe any symptomatic variation from normal menstruation and also includes intermenstrual bleeding. The Table below summarises the recommended terminology for women with AUB.
| Parameters | Terminology | Outwith 5th to 95th centile |
| Frequency of menses (days) | Absent | Amenorrhoea – Primary or Secondary |
| Infrequent | >38 days | |
| Frequent | <24 days | |
| Regularity (Cycle length) | Irregular | Variation >10 days – Cycle length is the number of days from the first day of one menstrual cycle to the first day of the next |
| Duration (days of bleeding in a single menstrual period) | Prolonged | >8 days |
| Volume (monthly blood loss) | Heavy or light | Subjectively defined |
| Spontaneous bleeds occurring in between periods | Intermenstrual bleeding (IMB) |
Cyclic (early, mid, late cycle) or random, Midcycle IMB may represent a nadir in estradiol levels (ovulation) and is physiological (9% of women) |
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Please refer to diagram above for primary care advice.
Obsandgynae.mailbox@borders.scot.nhs.uk