Abnormal uterine bleeding (AUB) is a common gynecological complaint in primary care and significantly affects women’s quality of life. Its heterogeneous etiologies make initial assessment challenging, and appropriate early evaluation is crucial for guiding management and referral decisions. Developing a clear, evidence-based protocol can support clinicians in standardizing initial care.To develop an evidence-based protocol for the initial assessment and management of AUB in non-pregnant women in the primary care setting.A narrative review was conducted using UpToDate, narrative and systematic reviews, clinical practice guidelines, and consensus statements published by recognized professional organizations in the last ten years. Sources addressing the evaluation and management of AUB in non-pregnant women were included. Literature focusing exclusively on pregnant patients or highly specialized interventions was excluded. Findings were synthesized to construct a practical and clinically applicable protocol. The synthesis emphasized diagnostic sequence, red-flag identification, and use of the FIGO PALM-COEIN classification system.The review supports a structured, stepwise approach to AUB in primary care. Initial evaluation requires assessment of hemodynamic stability, promptly identifying acute cases requiring urgent intervention. In stable patients, pregnancy must be excluded using a pregnancy test. A positive result warrants referral to obstetrics. If pregnancy is excluded, clinical assessment should proceed with a detailed history, focused physical examination, and targeted diagnostic testing guided by clinical suspicion. The PALM-COEIN framework provides a standardized method to categorize structural (PALM) and non-structural (COEIN) causes. Management options vary according to etiology, ranging from watchful waiting and medical therapy to referral for gynecological evaluation when specialized investigation or treatment is required.The findings highlight the importance of a systematic, evidence-based approach in primary care to improve diagnostic accuracy, avoid unnecessary delays, and ensure appropriate use of specialist services. Incorporating standardized classification tools such as PALM-COEIN enhances consistency in assessment and communication across care levels.The proposed protocol offers a clear, evidence-informed pathway for the initial evaluation of AUB in non-pregnant women in primary care, supporting timely diagnosis and appropriate referral. Its implementation may improve clinical decision-making and patient outcomes and provides a foundation for future research on protocol effectiveness in real-world practice.