715
Views
1
CrossRef citations to date
0
Altmetric
Review

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

ORCID Icon, , , , , , , & show all
Pages 504-517 | Received 07 Apr 2022, Accepted 08 Aug 2022, Published online: 02 Sep 2022

References

  • Fraser IS, Critchley HO, Broder M, et al. The FIGO recommendations on terminologies and definitions for normal and abnormal uterine bleeding. Semin Reprod Med. 2011;29(5):383–390.
  • Kazemijaliseh H, Ramezani Tehrani F, Behboudi-Gandevani S, et al. A population-based study of the prevalence of abnormal uterine bleeding and its related factors among Iranian reproductive-age women: an updated data. Arch Iran Med. 2017;20(9):558–563.
  • Davis E, Sparzak PB. Abnormal uterine bleeding. Treasure Island (FL): StatPearls; 2021.
  • Lunardi Rocha AL, Cristina Franca Ferreira M, Mara Lamaita R, et al. Heavy menstrual bleeding: a global survey of health care practitioners' perceptions. Eur J Contracept Reprod Health Care. 2018;23(4):288–294.
  • Fraser IS, Mansour D, Breymann C, et al. Prevalence of heavy menstrual bleeding and experiences of affected women in a european patient survey. Int J Gynaecol Obstet. 2015;128(3):196–200.
  • Schoep ME, Nieboer TE, van der Zanden M, et al. The impact of menstrual symptoms on everyday life: a survey among 42,879 women. Am J Obstet Gynecol. 2019;220(6):569 e1–569 e7.
  • Henry C, Ekeroma A, Filoche S. Barriers to seeking consultation for abnormal uterine bleeding: systematic review of qualitative research. BMC Womens Health. 2020;20(1):123.
  • Liu Z, Doan QV, Blumenthal P, et al. A systematic review evaluating health-related quality of life, work impairment, and health-care costs and utilization in abnormal uterine bleeding. Value Health. 2007;10(3):183–194.
  • Weisberg E, McGeehan K, Fraser IS. Effect of perceptions of menstrual blood loss and menstrual pain on women's quality of life. Eur J Contracept Reprod Health Care. 2016;21(6):431–435.
  • Munro MG, Critchley HO, Broder MS, FIGO Working Group on Menstrual Disorders, et al. FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age. Int J Gynaecol Obstet. 2011;113(1):3–13.
  • da Silva Filho AL, Caetano C, Lahav A, et al. The difficult journey to treatment for women suffering from heavy menstrual bleeding: a multi-national survey. Eur J Contracept Reprod Health Care. 2021;26(5):390–398.
  • Munro MG, Critchley HOD, Fraser IS, FIGO Menstrual Disorders Committee. The two FIGO systems for normal and abnormal uterine bleeding symptoms and classification of causes of abnormal uterine bleeding in the reproductive years: 2018 revisions. Int J Gynaecol Obstet. 2018;143(3):393–408.
  • Gynecologists ACoOa. ACOG committee opinion no. 557: management of acute abnormal uterine bleeding in nonpregnant reproductive-aged women. Obstet Gynecol. 2013;121(4):891–896.
  • Committee on Practice B-G. Practice bulletin no. 128: diagnosis of abnormal uterine bleeding in reproductive-aged women. Obstet Gynecol. 2012;120(1):197–206.
  • National Institute for Health and Care Excellence. Heavy menstrual bleeding: assessment and management. NICE guideline [cited 2021 Jan 1; published 2018 Mar 14]. Available from: www.nice.org.uk/guidance/ng88.
  • The Royal Australian and New Zealand College of Obstetricians and Gynaecologists. Investigation of intermenstrual and postcoital bleeding. Women’s Health Committee and RANZCOG Board and Council; 2018.
  • Singh S, Best C, Dunn S, et al. No. 292-abnormal uterine bleeding in pre-menopausal women. J Obstet Gynaecol Can. 2018;40(5):e391–e415.
  • Shapley M, Jordan J, Croft PR. A systematic review of postcoital bleeding and risk of cervical cancer. Br J Gen Pract. 2006;56(527):453–460.
  • Götz HM, van Bergen JE, Veldhuijzen IK, et al. A prediction rule for selective screening of Chlamydia trachomatis infection. Sex Transm Infect. 2005;81(1):24–30.
  • Shankar M, Lee CA, Sabin CA, et al. Von willebrand disease in women with menorrhagia: a systematic review. BJOG. 2004;111(7):734–740.
  • Toth M, Patton DL, Esquenazi B, et al. Association between Chlamydia trachomatis and abnormal uterine bleeding. Am J Reprod Immunol. 2007;57(5):361–366.
  • Aarnio M, Sankila R, Pukkala E, et al. Cancer risk in mutation carriers of DNA-mismatch-repair genes. Int J Cancer. 1999;81(2):214–218.
  • Kadir RA, Economides DL, Sabin CA, et al. Frequency of inherited bleeding disorders in women with menorrhagia. Lancet. 1998;351(9101):485–489.
  • Damsa C, Bumb A, Bianchi-Demicheli F, et al. “Dopamine-dependent" side effects of selective serotonin reuptake inhibitors: a clinical review. J Clin Psychiatry. 2004;65(8):1064–1068.
  • Thangavelu K, Geetanjali S. Menstrual disturbance and galactorrhea in people taking conventional antipsychotic medications. Exp Clin Psychopharmacol. 2006;14(4):459–460.
  • Bryk AH, Piróg M, Plens K, et al. Heavy menstrual bleeding in women treated with rivaroxaban and vitamin K antagonists and the risk of recurrent venous thromboembolism. Vascul Pharmacol. 2016;87:242–247.
  • Wise MR, Jordan V, Lagas A, et al. Obesity and endometrial hyperplasia and cancer in premenopausal women: a systematic review. Am J Obstet Gynecol. 2016;214(6):689.e1–689.e17.
  • Tsakiridis I, Giouleka S, Mamopoulos A, et al. Diagnosis and management of ectopic pregnancy: a comparative review of major national guidelines. Obstet Gynecol Surv. 2020;75(10):611–623.
  • Tsakiridis I, Chatzikalogiannis I, Mamopoulos A, et al. Cesarean scar pregnancy: a case report with surgical management after initially effective conservative treatment. Int J Surg Case Rep. 2019;65:238–241.
  • Tsakiridis I, Mamopoulos A, Kalogiannidis I, et al. Coexisting normal pregnancy with complete mole: a rare case report with successful pregnancy outcome. J Obstet Gynaecol. 2021;22:1–3.
  • Krassas GE, Pontikides N, Kaltsas T, et al. Disturbances of menstruation in hypothyroidism. Clin Endocrinol. 1999;50(5):655–659.
  • Krassas GE. Thyroid disease and female reproduction. Fertil Steril. 2000;74(6):1063–1070.
  • Attia AH, Youssef D, Hassan N, et al. Subclinical hyperthyroidism as a potential factor for dysfunctional uterine bleeding. Gynecol Endocrinol. 2007;23(2):65–68.
  • Kouides PA, Conard J, Peyvandi F, et al. Hemostasis and menstruation: appropriate investigation for underlying disorders of hemostasis in women with excessive menstrual bleeding. Fertil Steril. 2005;84(5):1345–1351.
  • Philipp CS, Faiz A, Dowling NF, et al. Development of a screening tool for identifying women with menorrhagia for hemostatic evaluation. Am J Obstet Gynecol. 2008;198(2):163 e1–8.
  • Villagrana Zesati JR, López Hurtado M, Flores Salazar VR, et al. Persistence of Chlamydia trachomatis in endometrium and peritoneal fluid of infertile patients with negative cervical culture. Ginecol Obstet Mex. 2013;81(1):23–28.
  • Vercellini P, Cortesi I, Oldani S, et al. The role of transvaginal ultrasonography and outpatient diagnostic hysteroscopy in the evaluation of patients with menorrhagia. Hum Reprod. 1997;12(8):1768–1771.
  • Breitkopf DM, Frederickson RA, Snyder RR. Detection of benign endometrial masses by endometrial stripe measurement in premenopausal women. Obstet Gynecol. 2004;104(1):120–125.
  • Dueholm M, Lundorf E, Hansen ES, et al. Evaluation of the uterine cavity with magnetic resonance imaging, transvaginal sonography, hysterosonographic examination, and diagnostic hysteroscopy. Fertil Steril. 2001;76(2):350–357.
  • van Dongen H, de Kroon CD, Jacobi CE, et al. Diagnostic hysteroscopy in abnormal uterine bleeding: a systematic review and meta-analysis. BJOG. 2007;114(6):664–675.
  • Bittencourt CA, Dos Santos Simões R, Bernardo WM, et al. Accuracy of saline contrast sonohysterography in detection of endometrial polyps and submucosal leiomyomas in women of reproductive age with abnormal uterine bleeding: systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2017;50(1):32–39.
  • Widrich T, Bradley LD, Mitchinson AR, et al. Comparison of saline infusion sonography with office hysteroscopy for the evaluation of the endometrium. Am J Obstet Gynecol. 1996;174(4):1327–1334.
  • Wolman I, Jaffa AJ, Hartoov J, et al. Sensitivity and specificity of sonohysterography for the evaluation of the uterine cavity in perimenopausal patients. J Ultrasound Med. 1996;15(4):285–288.
  • Leone FP, Lanzani C, Ferrazzi E. Use of strict sonohysterographic methods for preoperative assessment of submucous myomas. Fertil Steril. 2003;79(4):998–1002.
  • Clark TJ, Voit D, Gupta JK, et al. Accuracy of hysteroscopy in the diagnosis of endometrial cancer and hyperplasia: a systematic quantitative review. JAMA. 2002;288(13):1610–1621.
  • Dueholm M, Lundorf E, Hansen ES, et al. Accuracy of magnetic resonance imaging and transvaginal ultrasonography in the diagnosis, mapping, and measurement of uterine myomas. Am J Obstet Gynecol. 2002;186(3):409–415.
  • Mark AS, Hricak H, Heinrichs LW, et al. Adenomyosis and leiomyoma: differential diagnosis with MR imaging. Radiology. 1987;163(2):527–529.
  • Bazot M, Darai E. Role of transvaginal sonography and magnetic resonance imaging in the diagnosis of uterine adenomyosis. Fertil Steril. 2018;109(3):389–397.
  • Tsakiridis I, Evaggelinos D, Mamopoulos A. Multiple STUMPs in a 19-year-old woman: a rare case report. Hippokratia. 2019;23(2):96.
  • Farquhar CM, Lethaby A, Sowter M, et al. An evaluation of risk factors for endometrial hyperplasia in premenopausal women with abnormal menstrual bleeding. Am J Obstet Gynecol. 1999;181(3):525–529.
  • Friberg E, Orsini N, Mantzoros CS, et al. Diabetes mellitus and risk of endometrial cancer: a Meta-analysis. Diabetologia. 2007;50(7):1365–1374.
  • Bettocchi S, Ceci O, Vicino M, et al. Diagnostic inadequacy of dilatation and curettage. Fertil Steril. 2001;75(4):803–805.
  • Dijkhuizen F, Mol BWJ, Brölmann HAM, et al. The accuracy of endometrial sampling in the diagnosis of patients with endometrial carcinoma and hyperplasia: a meta-analysis. Cancer. 2000;89(8):1765–1772.
  • Benetti-Pinto CL, Rosa-E-Silva ACJS, Yela DA, et al. Abnormal uterine bleeding. Rev Bras Ginecol Obstet. 2017;39(7):358–368.
  • Kitawaki J, Akira S, Harada T, et al. Bleeding patterns of women with heavy menstrual bleeding or dysmenorrhoea using the levonorgestrel-releasing intrauterine system: results from a real-world observational study in Japan (J-MIRAI). Eur J Contracept Reprod Health Care. 2022;27(4):1–8.
  • Mawet M, Nollevaux F, Nizet D, et al. Impact of a new levonorgestrel intrauterine system, levosert((R)), on heavy menstrual bleeding: results of a one-year randomised controlled trial. Eur J Contracept Reprod Health Care. 2014;19(3):169–179.
  • Bofill Rodriguez M, Lethaby A, Jordan V. Progesterone or progestogen-releasing intrauterine systems for heavy menstrual bleeding. Cochrane Database Syst Rev. 2020;6(4):CD002126.
  • Davis A, Godwin A, Lippman J. Triphasic norgestimate-ethinyl estradiol for treating dysfunctional uterine bleeding. Obstet Gynecol. 2000;96(6):913–920.
  • Andersson JK, Rybo G. Levonorgestrel-releasing intrauterine device in the treatment of menorrhagia. Br J Obstet Gynaecol. 1990;97(8):690–694.
  • Marjoribanks J, Lethaby A, Farquhar C. Surgery versus medical therapy for heavy menstrual bleeding. Cochrane Database Syst Rev. 2006;19(2):Cd003855.
  • Petta CA, Ferriani RA, Abrao MS, et al. Randomized clinical trial of a levonorgestrel-releasing intrauterine system and a depot GnRH analogue for the treatment of chronic pelvic pain in women with endometriosis. Hum Reprod. 2005;20(7):1993–1998.
  • Fraser IS, Parke S, Mellinger U, et al. Effective treatment of heavy and/or prolonged menstrual bleeding without organic cause: pooled analysis of two multinational, randomised, double-blind, placebo-controlled trials of oestradiol valerate and dienogest. Eur J Contracept Reprod Health Care. 2011;16(4):258–269.
  • Fraser IS. Treatment of ovulatory and anovulatory dysfunctional uterine bleeding with oral progestogens. Aust N Z J Obstet Gynaecol. 1990;30(4):353–356.
  • Lethaby A, Irvine G, Cameron I. Cyclical progestogens for heavy menstrual bleeding. Cochrane Database Syst Rev. 2008;23(1):Cd001016.
  • Schwallie PC, Assenzo JR. Contraceptive use–efficacy study utilizing medroxyprogesterone acetate administered as an intramuscular injection once every 90 days. Fertil Steril. 1973;24(5):331–339.
  • Friedman AJ, Hoffman DI, Comite F, et al. Treatment of leiomyomata uteri with leuprolide acetate depot: a double-blind, placebo-controlled, multicenter study. The Leuprolide Study Group. Obstet Gynecol. 1991;77(5):720–725.
  • Colacurci N, De Placido G, Mollo A, et al. Short-term use of goserelin depot in the treatment of dysfunctional uterine bleeding. Clin Exp Obstet Gynecol. 1995;22(3):212–219.
  • Thomas EJ. Add-back therapy for long-term use in dysfunctional uterine bleeding and uterine fibroids. Br J Obstet Gynaecol. 1996;103(Suppl 14):18–21.
  • DeVore GR, Owens O, Kase N. Use of intravenous premarin in the treatment of dysfunctional uterine bleeding–a double-blind randomized control study. Obstet Gynecol. 1982;59(3):285–291.
  • Gleeson N, Devitt M, Sheppard BL, et al. Endometrial fibrinolytic enzymes in women with normal menstruation and dysfunctional uterine bleeding. BJOG. 1993;100(8):768–771.
  • Lukes AS, Moore KA, Muse KN, et al. Tranexamic acid treatment for heavy menstrual bleeding: a randomized controlled trial. Obstet Gynecol. 2010;116(4):865–875.
  • Willman EA, Collins WP, Clayton SG. Studies in the involvement of prostaglandins in uterine symptomatology and pathology. Br J Obstet Gynaecol. 1976;83(5):337–341.
  • Dawood MY. Nonsteroidal antiinflammatory drugs and reproduction. Am J Obstet Gynecol. 1993;169(5):1255–1265.
  • Lethaby A, Augood C, Duckitt K, et al. Nonsteroidal anti-inflammatory drugs for heavy menstrual bleeding. Cochrane Database Syst Rev. 2007;17(4):Cd000400.
  • Lethaby A, Farquhar C, Cooke I. Antifibrinolytics for heavy menstrual bleeding. Cochrane Database Syst Rev. 2000;(4):CD000249.
  • Ong YL, Hull DR, Mayne EE. Menorrhagia in von willebrand disease successfully treated with single daily dose tranexamic acid. Haemophilia. 1998;4(1):63–65.
  • James AH, Kouides PA, Abdul-Kadir R, et al. Evaluation and management of acute menorrhagia in women with and without underlying bleeding disorders: consensus from an international expert panel. Eur J Obstet Gynecol Reprod Biol. 2011;158(2):124–134.
  • Kadir RA, Lukes AS, Kouides PA, et al. Management of excessive menstrual bleeding in women with hemostatic disorders. Fertil Steril. 2005;84(5):1352–1359.
  • Leissinger C, Carcao M, Gill JC, et al. Desmopressin (DDAVP) in the management of patients with congenital bleeding disorders. Haemophilia. 2014;20(2):158–167.
  • Hamani Y, Ben-Shachar I, Kalish Y, et al. Intrauterine balloon tamponade as a treatment for immune thrombocytopenic purpura-induced severe uterine bleeding. Fertil Steril. 2010;94(7):2769.e13-5–2769.e15.
  • MacKenzie IZ, Bibby JG. Critical assessment of dilatation and curettage in 1029 women. Lancet. 1978;2(8089):566–568.
  • Lethaby A, Hickey M, Garry R, et al. Endometrial resection/ablation techniques for heavy menstrual bleeding. Cochrane Database Syst Rev. 2009;(4):CD001501.
  • Fergusson RJ, Bofill Rodriguez M, Lethaby A, et al. Endometrial resection and ablation versus hysterectomy for heavy menstrual bleeding. Cochrane Database Syst Rev. 2019;8(8):Cd000329.
  • Bowkley CW, Dubel GJ, Haas RA, et al. Uterine artery embolization for control of life-threatening hemorrhage at menarche: brief report. J Vasc Interv Radiol. 2007;18(1 Pt 1):127–131.
  • Levy-Zauberman Y, Pourcelot AG, Capmas P, et al. Update on the management of abnormal uterine bleeding. J Gynecol Obstet Hum Reprod. 2017;46(8):613–622.
  • Ash SJ, Farrell SA, Flowerdew G. Endometrial biopsy in DUB. J Reprod Med. 1996;41(12):892–896.

Reprints and Corporate Permissions

Please note: Selecting permissions does not provide access to the full text of the article, please see our help page How do I view content?

To request a reprint or corporate permissions for this article, please click on the relevant link below:

Academic Permissions

Please note: Selecting permissions does not provide access to the full text of the article, please see our help page How do I view content?

Obtain permissions instantly via Rightslink by clicking on the button below:

If you are unable to obtain permissions via Rightslink, please complete and submit this Permissions form. For more information, please visit our Permissions help page.