Abnormal Uterine Bleeding In Women Research Articles

Association of caesarean scar defect with risk of abnormal uterine bleeding: results from meta-analysis

ObjectiveTo investigate the association between caesarean scar defects and abnormal uterine bleeding through systematic literature review.MethodsPubMed, Web of Science, Cochrane Library and Embase databases were searched based on PRISMA 2020 to include studies exploring abnormal uterine bleeding in women with caesarean scar defects. The combined relative risk (RR) of uterine bleeding, combined prevalence of abnormal uterine bleeding and combined RR of intermenstrual uterine bleeding were calculated using a fixed- or random-effects model.ResultsTen studies involving 1,183 women with caesarean scar defects met the inclusion criteria for this study. Compared with women without caesarean scar defects, those with caesarean scar defects had a higher risk of abnormal uterine bleeding (RR: 3.22, 95% CI: 1.83–5.66) and intermenstrual bleeding (RR: 2.93, 95% CI: 1.91–4.50). The prevalence of abnormal uterine bleeding was approximately 0.46 (95% CI: 0.27–0.64), and across populations, women with a previous caesarean section who had undergone imaging specifically for gynaecological disease had a significantly higher prevalence of abnormal uterine bleeding (0.77, 95% CI: 0.65–0.89) than those with at least one caesarean Sect. (0.25, 95% CI: 0.10–0.39).ConclusionA significant association was observed between caesarean scar defects and abnormal uterine bleeding, with the former being a risk factor for the latter. However, previous studies have differed in the definition of caesarean scar defects and abnormal uterine bleeding, and more high-quality studies are needed to further investigate the relevant definitions and study results in the future.

New options for replenishing the iron stores in patients with abnormal uterine bleeding

Introduction. The high incidence of abnormal uterine bleeding (AUB) (over 30%) among patients of reproductive age is accompanied by the development of iron deficiency anaemia (IDA), which, in turn, is a social problem among global burden diseases throughout the world.Aim. To evaluate the clinical efficacy and compliance with the Vojea complex regimen to prevent IDA in women with abnormal uterine bleeding.Materials and methods. A multicentre clinical observational study was conducted in 6 health care facilities and women’s health clinics in Yekaterinburg and Moscow. The study included 52 patients with latent iron deficiency (serum ferritin level < 15 ng/ml) who were diagnosed with abnormal uterine bleeding (AUB) due to ovulatory dysfunction. All patients received Vojea complex at a dose of 1 tablet QD for 3 months while taking pharmaceutical therapy for AUB. The clinical and laboratory efficacy and medication compliance were assessed at 30, 60 and 90 days after initiation of treatment.Results. Starting from the 1st month of treatment with the study complex, positive trends in clinical and laboratory findings were observed in both groups. After the three-month therapy with Vojea, ferritin levels increased 5.4 times (a clinically significant growth was reported after the two-month intake), plasma folate levels increased 4.9 times and red blood cell folate concentrations increased by 45%. The complex therapy helped reach and maintain the average red blood cell folate concentration >400 ng/ml (906 nmol/l). Side effects included isolated events of gastrointestinal dyspepsia and individual intolerance. All patients reported good and excellent tolerance of the complex, which ensured high compliance with the drug regimen (92%).Conclusion. The three-month therapy with Vojea complex as part of the combination approach to the treatment of AUB in women with latent iron deficiency showed high clinical and laboratory efficacy, as well as good compliance with the drug regimen.

Causes of abnormal uterine bleeding in women of 20–60 years of age based on polyp, adenomyosis, leiomyoma, malignancy, coagulopathy, ovulatory dysfunction, endometrial, iatrogenic, and not-yet-classified at a tertiary care hospital: A cross-sectional study

Abstract Background: Approximately 10%–25% of women are affected with abnormal uterine bleeding (AUB). It is essential to have a thorough understanding and knowledge about the disease, causative factors, pathophysiology, incidence and prevalence of various causative factors, clinical presentations, and diagnostic aids for an early prediction and diagnosis of disease to treat the condition at the earliest possible phase and with minimum morbidity and costs. Objective: The objective of this study was to study the causes of AUB women of 20–60 years of age based on polyp, adenomyosis, leiomyoma, malignancy, coagulopathy, ovulatory dysfunction, endometrial, iatrogenic, and not-yet-classified (PALM COEIN). Materials and Methods: It was a hospital-based prospective study among 136 patients with AUB aged 20–60 years. History, general and gynecological examination, and routine gynecological examination were done using speculum examination of the vagina and the cervix and a bimanual examination. Routine investigations and an ultrasonography were done. Some were subjected to PAP smear as a routine procedure. Results: Women aged 31–50 years and multiparous were most affected with AUB in 84.6% and 88.9% of cases, respectively. According to the International Federation of Gynecology and Obstetrics type classification, the most common type of presentation was heavy menstrual bleeding in 54% of cases. The most common presenting symptom was pain in the abdomen in 4.4%. The most common-related symptom was spasmodic dysmenorrhea in 36%. The most common clinical sign was pallor in 25%. The most common associated comorbidity was anemia in 49%. Leiomyoma was the most common ultrasound diagnosis of underlying pathology in 52.2%. The most common cause of AUB as per PALM COEIN was AUB leiomyoma in 52.2%. Conclusion: Our study shows that the causation of AUB was multifactorial (though in some cases, solitary lesions were found) involving the entire female reproductive system resulting in a single common presentation as AUB.

STUDY OF ENDOMETRIAL PATHOLOGY IN ABNORMAL UTERINE BLEEDING

Objective: Endometrial pathology is becoming the most common issue that affects women of reproductive age group worldwide. AUB encompasses a wide variety of presentations, for example, frequent menstrual cycles, frequent and heavy cyclical bleeding, irregular bleeding, and postcoital bleeding. This study was done to evaluate the endometrial causes of AUB and to determine the specific pathology in different age groups.
 Methods: This study was a prospective cross-sectional study conducted on 200 patients from January 2023 to October 2023 in the department of pathology in a reputed teaching hospital and research centre. All the endometrial biopsies/curretages and hysterectomy specimens sent for Histopathological examination with history of AUB were included in the study.
 Results: Age of the patients with AUB ranged from 17 to 71 y in our study. Out of 200 cases, 90 cases (45%) were seen in Perimenopausal group followed by 68 cases (34 %) in Reproductive age group and 42 cases (21%) in Postmenopausal age group. Menorrhagia was the most common bleeding pattern seen in 54% pf patient with AUB. In 28% in reproductive age group, hormonal imbalance was observed in 13% of reproductive age group and 6% in perimenopausal age group. Atrophic endometrium was observed in 7.5% of women in post-menopausal age group. Chronic endometritis was seen 3% of reproductive age group.
 Conclusion: Abnormal uterine bleeding in women belonging to different age group show variable endometrial pattern on histopathological examination. They are valuable in early detection of pre-cancerous endometrial lesions as well as malignancy.

Abnormal uterine bleeding in women of reproductive age: PALM-COEIN causes

Objective: Abnormal uterine bleeding (AUB) is an often pathology in women of reproductive age. Materials and methods. The retrospective analysis of 336 patients with AUB was performed between 2017-2020. We analyzed the social and demographic data, reproductive function, somatic diseases, type and causes of AUB. Results. According to PALM-COEIN classification polyps were found in 13.39 % of patients, adenomyosis – 20.83 %, leiomyoma – 37.50 %, malignancy/hyperplasia – 14.29 %, ovulation disorders – 24.11 %, endometrial factor – 12.20 %, iatrogenic reason – 6.25 %. Conclusion. PALM-causes dominate over COEINetiological factors in the development of AUB in women of reproductive age. But, there are some differences in the rate of causes according to the age period. Bangladesh Journal of Medical Science Vol. 22 No. 04 October’23 Page : 809-814

Abnormal Uterine Bleeding in Women<40 Years and Its Risk Factors

Background: Abnormal uterine bleeding (AUB) is a common cause for outpatient and emergency department visits in reproductive-aged women and may have a significant impact on quality of life. Objective: The study aimed to determine the clinical risk factors for abnormal uterine bleeding in women <40 years age. Methods: This was a cross-sectional study conducted in the Obstetric & gynae department in Khwaja Yunus Ali medical college and hospital from January 2021 to December 2021. Clinical information was retrieved retrospectively from the patients' medical records. Results: 120 women of reproductive age with abnormal uterine bleeding participated in the study. Most of them were in the 36-40 age group. The patients' average age was 34.28 years. 88 (73.33%) had a large uterus, and 86 (70%) had atypical menstruation histories. Clinical symptoms included 35 (29.17%) heavy periods, 28 (23.33%) metrorrhagia, 22 (18.33%) polymenorrhea, 17 (14.17%) oligomenorrhea, 6 (5%) amenorrhea, and 12 (10%) reported symptoms of intermenstrual bleeding. After reviewing the medical records, it was discovered that 33 (27.5%) had diabetes, 37 (30.83%) had hypertension, 16 (13.33%) had both diabetes and hypertension, 7(5.63%) had hypothyroidism, 5 (4.17%) had cancer, 19(15.83%) were obese, and the majority of the patients, 87 (72.5%) were anemic. Multiple pregnancy was also a significant factors for AUB. Conclusion: AUB can be caused by factors such as increased age, obesity, nulliparity, irregular menstrual cycles, a history of diabetes, hypertension, and more. The only risk factor in the present study that was statistically significant was irregular menstruation history. Bulky uterus, multiple pregnancies, and irregular menstrual cycles may be related with abnormal uterine bleeding.

Clotting Factor Deficiencies as an Underlying Cause of Abnormal Uterine Bleeding in Women of Reproductive Age: A Literature Review.

Clotting Factor deficiencies are rare disorders with variations in clinical presentation and severity of symptoms ranging from asymptomatic to mild to life-threatening bleeding. Thus, they pose a diagnostic and therapeutic challenge, mainly for the primary health care providers, general practitioners, and gynecologists who are more likely to first encounter these patients. An additional diagnostic challenge arises from the variable laboratory presentations, as PT, PTT, and BT are not always affected. The morbidity is higher among women of reproductive age since Abnormal Uterine Bleeding-specifically Heavy Menstrual Bleeding-is one of the most prevalent manifestations of these disorders, and in some cases of severe deficiencies has led to life-threatening episodes of bleeding requiring blood transfusions or even immediate surgical intervention. Physician awareness is important as, in the case of some of these disorders-i.e., Factor XIII deficiency-prophylactic treatment is available and recommended. Although uncommon, the potential for rare bleeding disorders and for hemophilia carrier states should be considered in women with HMB, after more prevalent causes have been excluded. Currently, there is no consensus on the management of women in these instances and it is reliant on the physicians' knowledge.

The use of a short course of Ulipristal Acetate for acute abnormal uterine bleeding in women without uterine fibroids.

Ulipristal Acetate (UPA) is a synthetic selective progesterone receptor modulator. It is used as emergency contraception and to reduce pain and blood loss in women of reproductive age with uterine fibroids. The first mechanism of action is myometrial apoptosis, the second is on the hypo-thalamic-pituitary-ovarian axis and the third action, is an anti-proliferative effect on the endometrium. Mainly based on the latter two, UPA is increasingly used off-label in women with abnormal uterine bleeding (AUB) without fibroids. The aim of this paper is to find evidence for a short course of UPA to treat acute AUB without fibroids, performing a systematic review as well as scrutinising literature data on the pharmacokinetics and on short term bleeding control in women with fibroids. A systematic electronic literature review was performed in February 2022. Inclusion criteria were UPA administered to women without myomas in a setting of acute uterine bleeding. Further criteria included papers describing early bleeding control using UPA, deemed independent of the presence of fibroids, with specific attention to the median time to amenorrhoea. The main outcome measured was the bleeding control within 10 days. One case report was identified. The data on symptomatic women with fibroids using 5 mg or 10 mg daily revealed bleeding control was reported within 10 days in 81% and 89% respectively, with amenorrhoea in 57% and in 78% respectively. A short-term administration may prove effective in abnormal uterine bleeding irrespective of the presence of uterine fibroids. However, more randomised controlled trials are needed and should be performed before implementation in general clinical practice. A short course of Ulipristal acetate as promising treatment for acute uterine bleeding without fibroids.

Prognosis of abnormal uterine bleeding in women of reproductive age with extragenital disorders

The purpose of the study was to elaborate on a prognostic model for predicting the development of abnormal uterine bleeding in women of reproductive age with accompanying extragenital disorders based on mathematical methods.
 Materials and methods. The study, which was in 2019-2022, involved 100 women of reproductive age with AUB and accompanying extragenital disorders under observation, who made up the main group. The control group comprised 50 women of reproductive age undergoing medical checkups. On the basis of 23 diagnostic indicators, the most informative ones were mathematically selected for the prognosis of AUB in women with extragenital abnormalities.
 Results and their discussion. The prognosis of the risk of developing AUB in women of reproductive age with extragenital disorders was carried out on a double scale (0 – low probability, 1 – high probability). The search for diagnostically informative factors involved a set of 23 working indicators that were investigated in the examined patients using four levels of the risk scale. In order to solve this issue, the factors that have the greatest importance in the formation of the prognosis were selected using discriminant analysis methods, and a corresponding mathematical model was created. The classification functions made it possible to enter the practical plane and form rules for assessing the presence/absence of the risk of developing AUB in patients of reproductive age with extragenital disorders. The corresponding expressions are the following equations:
 NP = BAS ART*75.57+FSH*2.96+prolac*0.02+estrad*0.02-40.78
 PP = BAS ART*105.35+FSH*0.79+prolac*0.1+estrad*0.08-114.49,
 where NP is a negative prognosis, PP is a positive prognosis.
 If NP > PP, then the most likely prognosis is the absence of AUB in the patient; otherwise, if PP > NP – there is an increased risk of AUB.
 Conclusion. Pulsation index in the basal arteries of the uterus, FSH, prolactin and estrogens are prognostically significant indicators for predicting the risk of abnormal uterine bleeding in patients of reproductive age with extragenital disorders. The above formula, obtained from the conducted discriminant analysis, makes it possible to predict bleeding in a specific patient

Risk factors for the development of endometrial hyperplasia with abnormal uterine bleeding in women of reproductive age

Risk factors for the development of endometrial hyperplasia with abnormal uterine bleeding in women of reproductive age

Is metabolic syndrome a fellow traveler with abnormal uterine bleeding in women of reproductive age? A case–control study

Is metabolic syndrome a fellow traveler with abnormal uterine bleeding in women of reproductive age? A case–control study

Histopathological Evaluation of Abnormal Uterine Bleeding in Women of Reproductive and Perimenopausal Age Groups

Histopathological Evaluation of Abnormal Uterine Bleeding in Women of Reproductive and Perimenopausal Age Groups

The role of immunological factors in the development of abnormal uterine bleeding in women of reproductive age with extragenital disorders

The aim of the study was to assess the role of immunological factors in the development of abnormal uterine bleeding in women of reproductive age with extragenital disorders.
 Materials and methods. The study involved 100 women with abnormal uterine bleeding and accompanying extragenital disorders (main group) and 50 somatically healthy women (control group). Autoimmune antibodies to platelets, phagocytic activity of neutrophil granulocytes, concentration of circulating immune complexes (CICs), total level of membranotropic cytotoxic factors, content of CD4+T-helper subpopulations and cytotoxic CD8+T-killer lymphocytes were evaluated as immunological markers.
 Results of the study. The study showed that thrombocytopenia, caused by the presence of autoimmune antibodies to their own platelets, can be one of the pathogenic factors of bleeding in women with AUB. In 41 % of women with AUB, phagocytic reactions were found to be intense, which was expressed by an increase in chemotaxis and adhesion functions, and in 46 % of women by an increase in the absorption capacity of phagocytes. In the main group, 48 % of the examined women had insufficient phagocyte enzymatic activity, which was evidenced by a decrease in the index of completion of phagocytosis. In 79 % of women of the main group, violations of the formation and elimination of circulating immune complexes were detected. The formation of low-molecular-weight CICs in 82 % of women of this cohort contributed to the induction of autoimmune reactions. The total content of membranotropic cytotoxic factors, which was evaluated according to the lymphocytotoxic test, exceeded the reference values in 88 % of women of the main group. In the main group, the average content of CD4+ T-helpers was 23 % lower, and the content of suppressor CD8+ T-lymphocytes was twice as low compared to the control group, resulting in a significant increase in the immunoregulatory index by 30 %.
 Conclusion. The women of the main group with abnormal uterine bleeding were found to have a violation of the functional activity of cellular factors of innate immunity, accompanied by changes in the absorption and digestive capacity of phagocytic cells. Assessment of secondary adaptive reactions showed induction of humoral sensitization and formation of autoimmune reactions (presence of antiplatelet autoantibodies, increase in CICs and LCT, decrease in the subpopulation of CD8+-suppressor T-lymphocytes). The detected violations indicate the pathogenic role of immunological reactions in women with abnormal uterine bleeding

Octreotide for the treatment of abnormal uterine bleeding in women with bleeding and clotting disorders.

The present study provides observational evidence that octreotide may be efficacious for the management of refractory abnormal uterine bleeding in women with bleeding diatheses.

Структура патологии эндометрия в постменопаузе

Objective. To study the morphological pattern of endometrial pathology in the menopausal women considering clinical symptoms and duration of the menopausal period. Patients and methods. 1032 women in the postmenopause were observed. Clinical data, the results of ultrasound and pathomorphological examination were studied. All patients were divided into the following groups: group 1 consisted of patients with menopausal duration for 1–5 years; group 2 – for 6–10 years; group 3 – for 10–20 years; group 4 – for more than 20 years. Results. Abnormal uterine bleeding (AUB) was registered in 39% of patients from group 1, in 13% of patients both from group 2 and group 3, and in 7% of patients from group 4. Endometrial thickening according to the ultrasound results was observed in 39% of patients from group 1, in 58% of patients from group 2, in 53% of patients both from group 3 and group 4. The combination of AUB and increased endometrial thickness was found in 27% of patients from group 1, in 29% from group 2, in 34% from group 3, and in 40% from group 4. Functional changes in the endometrium represented by the regenerating endometrium, proliferative endometrium, and endometrial hyperplasia were found in 31% of patients from group 1 and in 4% of patients from group 2. The incidence of endometrial carcinoma increased with the increasing duration of the menopause and was 7% in group 1, 12% in group 2, 24% in group 3, and 30% in group 4. Conclusion. The leading cause of AUB in women during the first 5 years of the menopause is functional change in the endometrium. Patients with menopausal duration of more than 10 years and the presence of AUB constitute a risk group of developing endometrial carcinoma. Key words: abnormal uterine bleeding, menopause, endometrial carcinoma

Energies Alterations and Chakras’ Energies Deficiencies as One Cause of Abnormal Uterine Bleeding in Women

Energies Alterations and Chakras’ Energies Deficiencies as One Cause of Abnormal Uterine Bleeding in Women

Hysteroscopy in Abnormal Uterine Bleeding

Aims: To evaluate the role of hysteroscopy in abnormal uterine bleeding in women of reproductive age group and to correlate the hysteroscopic findings with histopathology.
 Methods: The study was carried out in the Department of Obstetrics and Gynecology at Patan Academy of Health Sciences, Kathmandu. Thirty patients of age group 20-61years with abnormal uterine bleeding were included. Demonstrable pelvic pathology like cancer of cervix, vagina or endometrium and active pelvic inflammatory disease (PID) were excluded. All patients were assessed using hysteroscopy and findings were correlated with histopathology.
 Results: On hysteroscopy, endometrium was normal in 30%, hyperplastic in 30%, polyps found in 20% and atrophic in 10%. Endometrial polyp and submucous fibroid was seen in 6.7% cases and 3.3% cases each. On confirmation by histopathology the findings were: normal endometrium in 40% cases, hyperplastic in 40%, polyp in 16.7% and atrophic in 3.3%. Submucous fibroid and suspicious endometrium came to be endometrial hyperplasia on histopathology.
 Conclusions: Hysteroscopy has more than 90% diagnostic accuracy to diagnose endometrial morphology and diagnostic agreement of endometrial finding is 63.33%.
 Keywords: abnormal uterine bleeding, hysteroscopy, predictive value

Comparison between Different Diagnostic Strategies in Low-Risk Reproductive Age and Pre-Menopausal Women Presenting Abnormal Uterine Bleeding.

Abnormal uterine bleeding (AUB) is a common symptom in the female population, with an estimated prevalence of 10 to 30% in fertile age and up to 90% in perimenopausal women. In most cases, AUB is due to a benign cause. However, it can also be a symptom of atypical endometrial hyperplasia or endometrial cancer, a more common disease during menopause which can also affect women in their reproductive age. Considering the high prevalence of this symptom an appropriate diagnostic algorithm is needed. Concerns about the risks, pain, and stress associated with an endometrial biopsy and its impact on the healthcare system make the choice of AUB diagnostic strategy extremely relevant. Even if the scientific community agrees on the definition of AUB, International Guidelines show some differences in the management of women of reproductive age with AUB, especially regarding the age cut-off as an independent indication for endometrial biopsy. This study compared different diagnostic strategies to identify a diagnostic pathway with high sensitivity and specificity but low impact on the health system’s resources. The analysis was based on three diagnostic algorithms defined as part of the guidelines of leading scientific societies. Women of reproductive age with AUB (n = 625) and without risk of endometrial cancer were included in the study. Results showed that the best criterion to investigate AUB in women at low risk of endometrial cancer is not age cut-off but the presence or absence of focal endometrial pathology at the ultrasound and the response to the progestin therapy. This approach makes it possible to perform fewer outpatient hysteroscopic biopsies without excluding positive cases from the examination.

Outpatient uterine assessment and treatment unit in patients with abnormal uterine bleeding: an economic modelling study.

Most often in Canada, the evaluation and management of abnormal uterine bleeding occurs under general anesthesia in the operating room. We aimed to assess the potential cost-effectiveness of an outpatient uterine assessment and treatment unit (UATU) compared with the current standard of care when diagnosing and treating abnormal uterine bleeding in women. We performed a cost-effectiveness analysis and developed a probabilistic decision tree model to simulate the total costs and outcomes of women receiving outpatient UATU or usual care over a 1-year time horizon (Apr. 1, 2014, to Mar. 31, 2017) at a tertiary care hospital in Ontario, Canada. Probabilities, resource use and time to diagnosis and treatment were obtained from a retrospective chart review of 200 randomly selected women who presented with abnormal uterine bleeding. Results were expressed as overall cost and time savings per patient. Costs are reported in 2018 Canadian dollars. Compared with usual care, care in the UATU was associated with a decrease in overall cost ($1332, 95% confidence interval [CI] -$1742 to -$1008) and a decrease in overall time to treatment (-75, 95% CI -89 to -63, d). The point at which the UATU would no longer be cost saving is if the additional cost to operate and maintain the UATU is greater than $1600 per patient. From the perspective of Canada's health care system, an outpatient UATU is more cost effective than usual care and saves time. Future studies should focus on the relative efficacy of a UATU and the total budget required to operate and maintain a UATU.

MODERN PRINCIPLES OF MANAGEMENT OF WOMEN WITH ABNORMAL UTERINE BLEEDING, TAKING INTO ACCOUNT THE BLOOD COAGULATION SYSTEM STATE

Abnormal uterine bleeding in women of childbearing potential requires effective emergency care. To determine the features of disorders in the hemostasis system, 120 women were directly examined at the time of bleeding on admission to the hospital, during treatment on days 5−7 of the menstrual cycle, as well as after 6−12 months from the end of treatment. Determination of congenital and acquired defects of the hemostasis system became the main criterion for the selection of combined and isolated forms of abnormal uterine bleeding. Treatment measures for patients were etiopathogenetically selected and individually the intensity of bleeding, the degree of anemia, coagulation parameters were taken into account. The staged treatment involved stopping the bleeding, regulating the menstrual cycle and further preventing the bleeding. It has been found that uterine bleeding in reproductive age in the absence of etiopathogenetic treatment leads to the development of posthemorrhagic anemia. The severity and nature of bleeding is determined by the presence of defects in the platelet system of the hemostasis system with impaired platelet aggregation function. The study of total coagulation potential, primary hemostasis and the state of intravascular hemocoagulation in the patients using the methods for estimating the amount of platelet aggregation allows to detect and differentiate disorders in the hemostasis system. According to the results of the study, it can be concluded that the use of fibrinolysis inhibitors in the patients with abnormal uterine bleeding helps to increase the activity of the blood coagulation system and complete cessation of bleeding on the 2nd−5th day. Prophylactic administration of antifibrinolytic drugs from the first day of the menstrual cycle reduces blood loss, stabilizes menstrual function and significantly improves the psycho−emotional state of patients. Key words: abnormal uterine bleeding, blood clotting, fibrinolysis inhibitors.