Investigation and management of abnormal uterine bleeding in reproductive-aged women: a descriptive review of national and international recommendations

Abstract

Purpose

To review and compare the most recently published recommendations on the investigation and management of abnormal uterine bleeding (AUB).

Materials and methods

A descriptive review of recommendations from the American College of Obstetricians and Gynaecologists (ACOG), the National Institute for Health and Care Excellence (NICE), the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG), the Society of Obstetricians and Gynaecologists of Canada (SOGC) and the International Federation of Gynaecology and Obstetrics (FIGO) on AUB in reproductive-aged women was carried out.

Results

There is a consensus that detailed personal and family history along with physical examination are essential in the investigation of menstrual, intermenstrual or postcoital AUB. All the medical societies recommend transvaginal ultrasound as the first-line imaging modality to determine the AUB cause. Moreover, they agree (except for RANZCOG) that, in women with AUB, endometrial biopsy should only be performed if additional risk factors for endometrial cancer are present. Laboratory tests may be helpful in the AUB investigation; however, there are several discrepancies among the recommendations. Regarding AUB management, NICE, ACOG and SOGC agree that the administration of hormonal or non-hormonal medications should be the first-line treatment modality in bleeding disorders and absent or minor structural pelvic pathology. Surgical management should be preferred in cases of identified polyps, large fibroids or unsuccessful pharmacological treatment.

Conclusions

Since AUB affects a significant proportion of reproductive-aged women, the main objective is to improve the quality of life of these patients without missing cases of malignancy.

摘要

目的：回顾和比较最近发表的关于异常子宫出血（AUB）的调查和管理建议。

材料和方法：对美国妇产科医师学会（ACOG）、美国国家健康与护理优化研究所（NICE）、澳大利亚和新西兰皇家妇产科医师学会（RANZCOG）、加拿大妇产科医师学会（SOGC）和国际妇产科联盟（FIGO）对育龄妇女AUB的建议进行了描述性回顾。

结果：专家一致认为, 详细的个人史和家族史以及体格检查在调查月经期、月经间期或性生活后的AUB时是必不可少的。所有医学会都建议将经阴道超声成像作为一线方式确定AUB病因。此外, 专家也一致认为（除RANZCOG外）, 对于有AUB的女性, 只有在存在子宫内膜癌的额外危险因素时才应进行子宫内膜活检。实验室检查可能对AUB的病因调查有帮助；但是, 这些建议之间存在一些差异。关于AUB的管理, NICE、ACOG和SOGC一致认为, 对于出血性疾病和不存在或轻微的盆腔结构性病变, 服用激素或非激素类药物应该作为一线治疗方式。在确定有息肉、大的纤维瘤或药物治疗不成功的情况下, 应首选手术治疗。

结论：由于AUB影响了很多的育龄期女性, 因此治疗的主要目标是不遗漏恶性肿瘤的情况下改善这些患者的生活质量。

Keywords:

• Abnormal uterine bleeding
• guidelines
• heavy menstrual bleeding
• intermenstrual bleeding
• investigation
• management

Disclosure statement

No potential conflict of interest was reported by the author(s).