Treatment Of Abnormal Uterine Bleeding Research Articles

DIAGNOSIS AND TREATMENT OF ABNORMAL UTERINE BLEEDING: A REVIEW OF THE LITERATURE

Introduction: Abnormal uterine bleeding is a medical condition that affects many women at different stages of their reproductive life and has been recognized as a significant public health concern. In recent years, the understanding of the causes and treatment options for this condition has evolved, reflecting the need for a comprehensive diagnostic and therapeutic approach. This condition is often related to hormonal imbalances, structural abnormalities, infections, and other gynecological diseases. Objective: To describe the importance of the diagnosis and therapeutic management of abnormal uterine bleeding, highlighting current clinical practices. Method: This is an integrative literature review, with the research question: what is the importance of the diagnosis and therapeutic management of abnormal uterine bleeding? The descriptors used were: “diagnosis,” “uterine bleeding,” and “therapeutics.” Searches were conducted in scientific platforms, resulting in the selection of 12 relevant articles published between 2019 and 2024. Results: The diagnosis of abnormal uterine bleeding is primarily based on specific clinical criteria, including a detailed menstrual history and physical examination. To confirm the condition, additional tests such as ultrasound and, in some cases, hysteroscopy are necessary, as well as excluding other potential causes like infections. The treatment of abnormal uterine bleeding varies depending on the identified cause and may include non-invasive options, such as hormonal medications, as well as surgical interventions for more severe cases. Conclusion: The management of abnormal uterine bleeding involves an individualized approach, starting with the identification of the underlying cause. Treatment may include the use of hormonal contraceptives and, when necessary, surgical interventions. Educating patients about their conditions and treatment options is essential for adherence to management and improving quality of life. Continuous follow-up and adaptation of treatment strategies are crucial to ensuring positive outcomes.

Comparison of Combined Oral Contraceptives and a Transdermal Estrogen Patch With Oral Progesterone: Treatment of Abnormal Uterine Bleeding in Adolescents

Comparison of Combined Oral Contraceptives and a Transdermal Estrogen Patch With Oral Progesterone: Treatment of Abnormal Uterine Bleeding in Adolescents

Diagnosis and management of abnormal uterine bleeding in adolescence

During menarche and adolescence, abnormal uterine bleeding (AUB) may serve as a crucial indicator of a hidden bleeding disorder. When a young woman is suspected of having a bleeding disorder, the obstetrician-gynecologist should collaborate with a hemostasis specialist to arrange the necessary laboratory testing and determine the best course of action. The Italian Society for the Study of Hemostasis and Thrombosis and the Italian Society of Gynecology and Obstetrics jointly offer recommendations on the diagnosis and treatment of AUB. They also suggest diagnostic and therapeutic pathways to decrease diagnostic delay and improve treatment effectiveness and safety.

Traits of intrauterine pathology management in the peri- and postmenopausal period

Increasing number of anovulatory cycles in the perimenopause, leading to relative hyperestrogenism, and persistent hypoestrogenism in postmenopause, increase the proliferative activity and change the endometrium morphology. That is associated with higher rates of intrauterine pathology. The prevalence of atypical hyperplasia and endometrial cancer in women of the peri- and postmenopausal periods reaches its maximum values. Therefore, one of the most important concepts of patient’s management is to exclude malignant and precancerous endometrial pathology. Significant hormonal changes leads to important confounders in diagnostic and therapeutic algorithms. It could lead to both hypo- and hyperdiagnosis. The review analyzes the main causes of abnormal uterine bleeding, the features of their clinical manifestation, taking into account probable iatrogenic causes, extrauterus and extragenital sources of spotting. This article reviews the principles of ultrasound examination, considering menstrual cycle phase, duration of menopause, hormone treatment, as well as indications for endometrial biopsy, in case of inconsistency of clinical presentation, ultrasound results, menopausal status and iatrogenic factors. We describe the relevant principles of medical correction, wait-and-see tactics and surgical treatment of abnormal uterine bleeding, both in the presence of organic pathology of the endometrium, and in its absence.

First and second-generation endometrial ablation devices: A network meta-analysis

ObjectiveFirst-generation and second-generation endometrial ablation (EA) techniques, along with medical treatment and invasive surgery, are considered successful lines of management for abnormal uterine bleeding (AUB). We set out to determine...

Abnormal uterine bleeding after COVID-19 vaccination in South Korea

Abstract Background: Various adverse reactions have been reported after vaccination against COVID-19. Objective: Few studies to date, however, have analyzed uterine bleeding after COVID-19 vaccination. The present study therefore evaluated the incidence of abnormal uterine bleeding after COVID-19 vaccination in South Korea. Methods: Data on suspected adverse reactions to COVID-19 vaccination reported to the Korea Disease Control and Prevention Agency from February 26, 2021, to June 29, 2023 (week 121), were analyzed. Subjects who experienced abnormal uterine bleeding were identified, and the incidence of abnormal uterine bleeding was compared among the types of COVID-19 vaccines administered. Results: . During the study period, 135,894,788 doses of COVID-19 vaccine were administered, with suspected adverse reactions occurring after administration of 483,391 doses (3.56 adverse reactions per 1,000 vaccinations) and abnormal uterine bleeding observed after administration of 6,288 doses (4.9 per 100,000 vaccinations). Conclusions: Abnormal uterine bleeding was the fifteenth most common adverse reaction after COVID-19 vaccination. Studies are needed to clarify the causal relationships of vaccination and type of vaccine with abnormal uterine bleeding, as well as to develop protocols for the diagnosis and treatment of abnormal uterine bleeding after COVID-19 vaccination.

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.

Contributing factors related to abnormal uterine bleeding in perimenopausal women: a case-control study.

Abnormal uterine bleeding (AUB) during the menopausal transition results in reproductive endocrine disorders and both physiological and pathological changes, substantially impacting women's health. This study aimed to investigate the factors influencing AUB in perimenopausal women. Between April 2021 and June 2022, 120 perimenopausal women with AUB in the menopausal transition, diagnosed and treated at the Gynaecology Department of Kunming Tongren Hospital, were included in the case group. Concurrently, women undergoing routine health examinations at the same hospital were randomly selected as the control group. Univariate and multivariate logistic regression analyses identified factors related to AUB. The univariate analysis revealed significant associations (P < 0.05) between AUB and several factors, including age, body mass index (BMI), age at menarche, gravidity, and intrauterine device (IUD) placement in perimenopausal women. The multivariate regression analysis indicated that the independent risk factors for AUB include benign endometrial lesions (odds ratio [OR] 5.243, 95% confidence interval [CI] 3.082-9.458, P < 0.001), endometrial thickness ≥ 10mm (OR 1.573, 95% CI 0.984-3.287, P < 0.001), age ≥ 50years (OR 2.045, 95% CI 1.035-4.762, P = 0.001), BMI ≥ 25kg/m2 (OR 2.436, 95% CI 1.43-4.86, P = 0.002), and IUD placement (OR 2.458, 95% CI 1.253-4.406, P < 0.001). Abnormal uterine bleeding during the menopausal transition is associated with several factors, including age, BMI, and IUD placement, highlighting the importance of early screening for these risk factors in the diagnosis and treatment of AUB.

A comparison of the effects of oral dydrogesterone and levonorgestrel-releasing intrauterine device on quality of life and sexual function in patients with abnormal uterine bleeding.

The purpose of this study is to compare the effects of cyclic oral dydrogesterone treatment and levonorgestrel-releasing intrauterine device (LNG_IUD) on quality of life (QoL) and sexual function in patients diagnosed with abnormal uterine bleeding (AUB). The study was conducted at the University of Health Sciences Turkey Health Istanbul Kanuni Sultan Süleyman Training and Research Hospital, on 171 sexually active patients, aged 18-45, who were under a minimum of 6months of treatment for AUB. 85 patients were treated with oral cyclic dydrogesterone, and 86 patients received LNG-IUD. Following a minimum of 6 months of treatment, these patients were recruited to the study and were asked to complete a 36-Item Short Form Survey (SF-36) and the Female Sexual Function Index (FSFI). When the FSFI scores of the patients were compared, it was observed that the total FSFI score was significantly higher in the cyclic dydrogesterone group (p < 0.05). Likewise, it was observed that sexual desire, arousal, and lubrication domains were significantly higher in the cyclic dydrogesterone group (p < 0.05). No significant differences were found between the treatment groups in 7 out of the 8 dimensions of SF-36. The energy/vitality dimension was found to be significantly higher in the cyclic dydrogesterone group. Total FSFI score, as well as sexual desire, arousal, and lubrication scores, were significantly higher in the cyclic dydrogesterone group compared to the LNG-IUD group indicating that cyclic dydrogesterone has a more positive impact on sexual function when compared to LNG-IUD.

Therapeutic Carbohydrate Restriction as a Metabolic Modality for the Prevention and Treatment of Abnormal Uterine Bleeding.

Therapeutic carbohydrate restriction diets have been becoming increasingly popular over the years, resulting in dramatic weight loss and an improvement in metabolic disorders. Obesity, insulin resistance, and diabetes are the risk factors for many gynecologic morbidities such as uterine leiomyoma, endometrial polyps, and polycystic ovarian syndrome. There is evidence suggesting that the pathogenesis of cardiovascular disease is similar to that seen in many causes of abnormal uterine bleeding. We aim to explain how cardiovascular disease risk factor reduction with the use of therapeutic carbohydrate restriction may prevent and potentially treat these gynecologic disorders.

Phyto-progestins for the treatment of abnormal uterine bleeding without organic cause in women at high risk for breast cancer and breast cancer survivors: a prospective, pilot study

Objectives Some plants, such as Dioscorea Villosa (DV), Vitex Agnus Castus (VAC) and Turnera diffusa (D) have some ‘progesterone-like’ properties. We have investigated their simultaneous administration in breast cancer (BC) survivors or carriers of specific genetic mutations that can increase the risk of developing BC suffering from abnormal uterine bleeding without organic cause. Methods Women with irregular cycles in terms of length (interval between ≤ 24 or ≥ 38 days) without a uterine organic disease (polyps, adenomyosis, fibroids, hyperplasia/malignancy) were included. A daily diary of bleeding, questionnaires about health-related quality of life (Short Form 36) and menstrual psychophysical well-being (PGWB-1) and the Greene Climacteric Scale (GCS) (in women older than 40 years old) questionnaire were used. The presence of some premenstrual syndrome (PMS) symptoms was also evaluated. Results In the analyzed group of women (n = 15), all experienced a regularization of the menstrual cycles, with a mean duration in the three months of use of 27.1 ± 3.2 days, with a significant reduction of menstrual pain (p = 0.02) and flow (p = 0.02) intensity. Women with PMS (7/15) reported an impovement in depression, headache and abdominal pain scores (p < 0.05). No specific deterioration of different questionnaires evaluated during treatment were observed. General satisfaction with the treatment was 6.8 ± 0.3/10 on a 10 point. Conclusions A combination of DV, VAC and D could be a promising candidate to treat menstrual irregularities without an organic cause, with a significant reduction of menstrual pain and flow intensity and possible additional benefits in PMS symptoms treatment in women at genetic risk for BC and BC survivors.

Perimenopausal abnormal uterine bleeding

Abnormal uterine bleeding is a very frequent symptom in the perimenopause. The causes are numerous ranging from physiological reactions due to decreasing/instable ovarian function to premalignant and malignant conditions. Benign findings such as endometrial polyps and myomas are increasing with age, leading to more abnormal uterine bleeding in the perimenopause. Cervical and vaginal causes of abnormal uterine bleeding should also be excluded by speculum examination. Sexually transmitted diseases should be ruled out in the perimenopausal women in new relationships. Measurement of hemoglobine, human chorion gonadotropine and thyreoid hormones are relevant in selected cases. Transvaginal ultrasound is the primary diagnostic tool in perimenopausal abnormal uterine bleeding. Saline or gel contrast sonohysterography improves the diagnostic accuracy. Based on the findings by ultrasound, more invasive procedures such as blind endometrial biopsy or hysteroscopy can be planned. Once premalignant and malignant causes are excluded, the necessity for treatment can be evaluated in collaboration with the individual woman. Severe heavy menstrual bleeding causing anaemia will need immediate treatment. In less severe cases and in intermenstrual bleeding expectant management can be considered. Hormonal medical treatment e.g., progestins or insertion of levonorgestrel-releasing intrauterine system (LNG-IUS) is a possibility in case of anovulatory bleeding interfering with the quality of life. The amount of bleeding can be reduced both by antifibrinolytic and non-steroidal anti-inflammatory drugs and LNG-IUS. In case of focal intrauterine lesions, such as endometrial polyps or submucous myomas, operative hysteroscopic procedures are warranted in the treatment of abnormal uterine bleeding. Other minimally invasive procedures, such as endometrial ablation or endometrial resection, is a good choice in selected cases, but some women will need a hysterectomy as a definite treatment of abnormal uterine bleeding in perimenopause.

PREMENOPAUSAL PERIOD AND ABNORMAL UTERINE BLEEDING

The article describes the analysis of abnormal uterine bleeding in premenopausal women, studies the causes and methods of treatment. The study was conducted in the gynecological department of the 1st clinic of the Samarkand State Medical University for 2021-2022. The study used general medical, clinical laboratory and instrumental diagnostic methods. The study investigated the causes and treatments for abnormal uterine bleeding and recommendations for improving treatment methods are given.

Endometrial ablation by trichloroacetic acid in abnormal uterine bleeding: A prospective interventional study

To evaluate the effectiveness of 50% Tricolored acetic acid (TCA) instillation in uterine cavity for the treatment of Abnormal uterine bleeding (AUB). In this study, 40 patients with the complaints of Abnormal menstrual bleeding, without any organic cause after ruling out malignancy were taken into consideration. After individually calculating the volume of TCA, it was instilled into the uterine cavity for chemically ablation of the endometrium. After a follow-up of 3 months, out of 40 patients, 53% reported hypo menorrhea and 27% reported amenorrhoea in contrast to 20% patients who had persistent symptoms. The study suggested that endometrial ablation with TCA is simple, cost effective, does not require longer hospital stay,can be done as an OPD procedure,do not require any sophisticated instrumentation and can be easily performed at primary health care centres after proper evaluation. However, to be used on regular basis, this method requires more randomised controlled trials.

Treatment of abnormal uterine bleeding using levonorgestrel-releasing intrauterine devices: experience from a Turkish tertiary hospital.

We evaluated the efficacy of the levonorgestrel-releasing intrauterine device in treating menorrhagia using a pictorial blood assessment chart. We retrospectively examined 822 patients treated with a levonorgestrel-releasing intrauterine device for abnormal uterine bleeding between January 1, 2017, and December 31, 2020, at a Turkish tertiary hospital. A pictorial blood assessment chart was used to determine each patient's blood loss amount, which involves the use of an objective scoring system to determine the amount of bleeding in towels, pads, or tampons. Descriptive statistical values were presented as mean and standard deviation, and paired sample t-tests were used for within-group comparisons of normally distributed parameters. Moreover, in the part of the descriptive statistical analysis, the mean and median values for the non-normally distributed tests were not close to each other, indicating that the data obtained and analyzed in this study had a non-normal distribution. Of 822 patients, 751 (91.4%) exhibited a significant reduction in menstrual bleeding after device insertion. Moreover, a significant decrease was observed in the pictorial blood assessment chart scores 6 months postoperatively (p < 0.05). This study revealed that the levonorgestrel-releasing intrauterine device is an easy-to-insert, safe, and effective treatment option for abnormal uterine bleeding (AUB). Furthermore, the pictorial blood assessment chart is a simple and reliable tool for evaluating menstrual blood loss in women before and after the insertion of levonorgestrel-releasing intrauterine devices.

Value and influencing factors of preoperative MRI evaluation for previous cesarean scar defect associated abnormal uterine bleeding in patients undergoing laparoscopic surgery.

As the cesarean section rate increases year by year, the treatment of previous cesarean scar defects (PCSD) poses a significant challenge. This study aims to evaluate the clinical value of preoperative magnetic resonance imaging (MRI) technology and analyze relevant influencing factors for patients with abnormal uterine bleeding (AUB) associated with cesarean scar defects who underwent laparoscopic surgery. A retrospective cohort analysis was performed on women who underwent laparoscopic surgery for PCSD-related AUB at the Department of Gynecology, the Third Xiangya Hospital of Central South University from 2018 to 2022. A total of 57 patients who underwent laparoscopic surgery for the treatment of AUB associated with PCSD were divided into 2 groups based on their postoperative clinical cure status: The clinically-cured group (n=28, 49.1%) and the non-clinically-cured group (n=29, 50.9%). After a postoperative follow-up period of 3 months for all participants, logistic regression analysis was conducted to explore the correlation between the clinical cure rate of AUB associated with cesarean scar defects treated by laparoscopic surgery and various factors. These factors included patient age, clinical symptoms, obstetric history, history of cesarean section, basic clinical information, preoperative MRI parameters, and postoperative menstrual conditions. There were no significant differences in many aspects, including the patient's age at the time of previous cesarean section, number of pregnancy, time since the previous cesarean section, the uterus position assessed by preoperative T2 signal MRI, defect length, defect width, residual muscle layer thickness, adjacent uterine muscle layer thickness, and distance from the defect to the external cervical os between the 2 groups (all P>0.05). However, the time of onset of AUB symptoms (P=0.036, OR=1.019, 95% CI 1.002 to 1.038) and the depth of the defect on the preoperative MRI (P=0.010, OR=5.793, 95% CI 1.635 to 25.210) were identified as risk factors affecting the clinical cure rate. The time of onset of AUB symptoms and the depth of the defect on preoperative MRI are risk factors that influence the clinical cure rate of laparoscopic surgery for the treatment of AUB associated with PCSD, which could be helpful for evaluating the prognosis of disease.

Treatment of Abnormal Uterine Bleeding Due to a Leiomyoma in a Bicornuate Uterus with Uterine Artery Embolization: The First Case in the Literature

Treatment of Abnormal Uterine Bleeding Due to a Leiomyoma in a Bicornuate Uterus with Uterine Artery Embolization: The First Case in the Literature

8771 The Impact of Social Determinants of Health Delaying Treatment for Women That Undergo Hysterectomy for Abnormal Uterine Bleeding

<h3>Study Objective</h3> 1) Identify the social determinants of health that contribute to delayed treatment for abnormal uterine bleeding (AUB), defined as women presenting with large uteruses at the time of hysterectomy, and patterns of healthcare utilization over a 3-year period and 2) Assess health-related outcomes in women with delayed hysterectomy for AUB. <h3>Design</h3> Retrospective cohort study. <h3>Setting</h3> Single hospital system. <h3>Patients or Participants</h3> 1,361 women who underwent hysterectomy for benign causes of abnormal uterine bleeding over a 3-year period between January 1, 2014, to December 31, 2017. <h3>Interventions</h3> N/A. <h3>Measurements and Main Results</h3> Women with enlarged uteri ≥ 500 g at time of hysterectomy were more likely to present to the emergency department (10.9% vs. 7.0%, p=0.034) and subspecialty care visits (34.2% vs. 28.0%, p=0.047). There were no differences in generalist gynecological visits among the two groups. Black women disproportionately composed those with enlarged uteri (59.9% vs. 36.1%, p=<0.001). There were no differences identified in age, BMI, socioeconomic status, ethnicity or insurance type. Women who delayed treatment for AUB were more likely to undergo mini-laparotomy (2.7% vs. 0.8%, p=0.01) or laparotomy (68.9% vs. 24.2%, p=<0.001) compared to minimally invasive approaches, demonstrated lower pre-operative hemoglobin levels (11.5 vs. 12.3, p=<0.001), lower hemoglobin levels in a 3-year period leading up to hysterectomy (10.0 vs. 11.3, p=<0.001), increased estimated blood loss (373.3mL vs. 178.7mL, p=<0.001), procedure time (171.9 min vs. 145.1min, p=<0.001) and length of hospital stay (1.4 days vs. 0.6 days, p=<0.001). <h3>Conclusion</h3> Delayed treatment for women who ultimately underwent hysterectomy for abnormal uterine bleeding was associated with increased emergency department and subspecialty care visits, and this population was disproportionately composed of Black woman. Perioperatively, delayed treatment was associated with more open surgeries, increased blood loss, increased operative time, and longer hospital stays.

Robotic hysterectomy for the treatment of refractory menometrorrhagia and squamous endometrial morules: A case report

Introduction: Abnormal uterine bleeding (AUB) is a common presentation in the field of gynecology. Proper diagnosis and management of this condition can be difficult and permanent treatment options, including robotic hysterectomy, may be necessary. In patients with a history of previous abdominal surgery, pelvic adhesions may present obstacles to this surgical approach. Case Report: In this case report, a 41-year-old woman desired permanent treatment for AUB. The patient underwent endometrial biopsy which revealed inexplicit squamous morules. She opted for permanent treatment via robotic hysterectomy. Her operation was complicated by the presence of dense pelvic adhesions caused by previous surgeries. Conclusion: This report aims to detail the potential difficulties in the clinical management of inconclusive biopsy results and in using a robotic approach to hysterectomy in the setting of pelvic adhesions. Authors encourage ongoing clinical investigation to determine the optimal methods for diagnosing and treating AUB.

Clinical Update on Uses for Mifepristone in Obstetrics and Gynecology.

Mifepristone (RU-486) is a selective progesterone receptor modulator that has antagonist properties on the uterus and cervix. Mifepristone is an effective abortifacient, prompting limitations on its use in many countries. Mifepristone has many uses outside of induced abortion, but these are less well known and underutilized by clinicians because of challenges in accessing and prescribing this medication. To provide clinicians with a history of the development of mifepristone and mechanism of action and safety profile, as well as detail current research on uses of mifepristone in both obstetrics and gynecology. A PubMed search of mifepristone and gynecologic and obstetric conditions was conducted between January 2018 and December 2021. Other resources were also searched, including guidelines from the American College of Obstetricians and Gynecologists and the Society of Family Planning. Mifepristone is approved by the Food and Drug Administration for first-trimester medication abortion but has other off-label uses in both obstetrics and gynecology. Obstetric uses that have been investigated include management of early pregnancy loss, intrauterine fetal demise, treatment of ectopic pregnancy, and labor induction. Gynecologic uses that have been investigated include contraception, treatment of abnormal uterine bleeding, and as an adjunct in treatment of gynecologic cancers. Mifepristone is a safe and effective medication both for its approved use in first-trimester medication abortion and other off-label uses. Because of its primary use as an abortifacient, mifepristone is underutilized by clinicians. Providers should consider mifepristone for other indications as clinically appropriate.