Management of abnormal uterine bleeding sciencedirect. The medical management in primary care remains the mainstay for initial treatment of this common. Anovulatory or dysfunctional uterine bleeding dub dysfunctional uterine bleeding is the occurrence of uterine bleeding unrelated to structural abnormalities of the uterus or the endometrial lining. It may be caused by trauma, a foreign body such as toys, coins, or toilet tissue, irritation of the genital area due to bubble bath, soaps, lotions, or infection, or urinary tract problems. Jan 01, 2012 terms associated with abnormal uterine bleeding are inconsistently defined in the literature, complicating the approach to evaluation and management. All such women therefore need uterine assessment, which may include transvaginal scan combined with endometrial biopsy, hysteroscopy or a sonohysterogram. In patients with identifiable causes, treatment is targeted toward the cause. It is responsible for about half of the women with abnormal uterine bleeding in reproductive age ewenstein, 1996. Chronic heavy or prolonged uterine bleeding can result in anemia, interfere with daily activities, and raise concerns about uterine. The rapid evolution in ambulatory hysteroscopy ah has transformed the approach to diagnose and manage abnormal uterine bleeding aub. Prepared by the vanderbilt evidencebased practice center under contract no.
Abnormal uterine bleeding around the time of the menopause is common and may be a sign of premalignancy such as endometrial hyperplasia or even endometrial carcinoma. The management of abnormal uterine bleeding depends on the etiology of the bleeding. A common and often debilitating condition, affecting women of reproductive age. The questions too much abnormal uterine bleeding differential and approach to work. We constructed a concise but comprehensive algorithm for the management of abnormal uterine bleeding between menarche and menopause. Basic palmcoein classification system for the causes of abnormal uterine bleeding in nonpregnant reproductiveaged women. Evaluation and management of abnormal uterine bleeding in. Although many etiologies cause aub, the one most likely cause among adolescents are dysfunctional uterine bleeding dub. Aub may be accompanied by pain and discomfort, cause significant social embarrassment, and have a substantial effect on healthrelated quality of life.
Abnormal uterine bleeding is an extremely common indication for referral to a gynaecologist. Severe acute bleeding irregular bleeding menorrhagia secondary amenorrhea pregnant figure 3 figure 4 figure 5 figure 6 figure 2 any abnormal pattern associated with certain. This guideline provides recommendations to gynaecologists and other health care providers in the diagnosis and management of abnormal uterine bleeding, incorporating the current evidence. Primary care management of abnormal uterine bleeding.
Chronic anovulation can lead to irregular bleeding. Medical management recommendations for abnormal uterine bleeding. National collaborating centre for womens and childrens health, national institute of clinical excellence. Abnormal uterine bleeding aub is defined as changes in frequency of menses, duration of flow or amount of blood loss. Abnormal uterine bleeding etiology bmj best practice. Abnormal uterine bleeding has various definitions and.
One national study found that menstrual disorders were the reason for 19. Evaluation and management of adolescents with abnormal uterine bleeding tanya l. About onethird of all women experience abnormal uterine bleeding aub sometime during their lifetime and aub can impair quality of life. Aub leads to loss of productivity1 and may result in surgical interventions including hysterectomy2.
Abnormal uterine bleeding is a common problem,1 and its management can be complex. Cer 96 primary care management of abnormal uterine bleeding. Chronic abnormal uterine bleeding aub, a term that refers to menstrual bleeding of abnormal quantity, duration, or schedule, is a common gynecologic problem, occurring in approximately 10 to 35 percent of women. Abnormal uterine bleeding aub may be acute or chronic and is defined as bleeding from the uterine corpus that is abnormal in regularity, volume, frequency, or duration and occurs in the absence of pregnancy 1 2.
A pregnancy that implants outside of the uterus, usually in the fallopian tube. American college of obstetricians and gynecologists. Full text management of abnormal uterine bleeding focus. There is specific therapy for hypothyroidism and a coagulopathy. Medical management of abnormal uterine bleeding in.
It is a diagnosis of exclusion made after structural causes of bleeding and chronic medical diseases have been ruled out. This chapter examines the modes of presentation and the causes of such symptoms, which range from physiological variations to more sinister underlying pathology. Abnormal uterine bleeding symptoms, diagnosis and treatment. Abnormal uterine bleeding between menarche and menopause do history and physical exam. Approach to diagnosis and management of abnormal uterine bleeding. Abnormal uterine bleeding related to ovulatory dysfunction i. We focused on interventions that are suitable for use in primary care practice including medical, behavioral, and complementary and alternative medicine approaches. Michael evans developed the onepager concept to provide clinicians with useful clinical information on primary care topics. The medical management in primary care remains the mainstay for. Management of abnormal uterine bleeding 3 treatment could be initiated in a primary care setting or in 1. Clinical practice clinical update d ysfunctional uterine bleeding dub is defined as excessively heavy, prolonged or frequent bleeding of uterine origin that is not due to pregnancy or any recognisable pelvic or systemic disease. Abnormal uterine bleeding aub is very common in women of every age group from. Acute aub refers to an episode of heavy bleeding that, in the opinion of the clinician, is of sufficient quantity to require immediate intervention to prevent further blood. Abnormal uterine bleeding aub may be acute or chronic and is defined as bleeding from the uterine corpus that is abnormal in regularity, volume, frequency, or duration and occurs in the absence of pregnancy.
Introduction abnormal uterine bleeding aub is a common problem among women in the reproductive age. Joint rcog, bsge and bgcs guidance for the management. Abnormal uterine bleeding aub is a condition that affects approximately 30% of women during their reproductive years. Abnormal uterine bleeding aub is a frequent cause of visits to health care provider during adolescent period and is characterized by irregular, excessively heavy, prolonged andor frequent bleeding of uterine origin. The management of perimenopausal abnormal uterine bleeding. In the treatment of women with abnormal uterine bleeding, once a thorough history, physical examination, and indicated imaging studies are performed and all significant structural causes are excluded, medical management is the firstline approach. The term dysfunctional uterine bleeding is a diagnosis of exclusion, reached when. Evaluation and management of abnormal uterine bleeding. The medical management of abnormal uterine bleeding in. Health care practitioners deal with this problem frequently. Abnormal uterine bleeding aub is a common problem among women in the reproductive age. Up to 14 percent of women experience irregular or excessively heavy menstrual bleeding. The guideline advisory committee gac database, the canadian medical association infobase for guidelines, and clinical evidence were also searched.
Because of this complexity, concise guidelines have been difficult to develop. Management of acute abnormal uterine bleeding in nonpregnant. Abnormal uterine bleeding in young girls bleeding before menarche the first period in a girls life is always abnormal. Management of abnormal uterine bleeding in reproductive. Evaluation and management of adolescents with abnormal. Abnormal uterine bleeding 1 abnormal uterine bleeding karen carlson, md assistant professor department of obstetrics and gynecology university of nebraska medical center 2 abnormal uterine bleeding. Interventions included the levonorgestrel intrauterine. Determining the acuity of the bleeding, the patients medical history, assessing risk factors, and establishing a diagnosis will.
Evaluation and management of abnormal uterine bleeding mayo. Joint rcog, bsge and bgcs guidance for the management of. Cer 96 primary care management of abnormal uterine. Menorrhagia and uterine fibroids account for up to 75 percent of all hysterectomies performed worldwide. Dysfunctional uterine bleeding describes the sp ectrum of abnormal bleeding patterns in the abscence of a medical illness or pelvic pathology. Acog releases guidelines on management of abnormal uterine. Abnormal uterine bleeding is a broad term that indicates a change in frequency of menses, duration of flow or amount of blood loss. Management of abnormal uterine bleeding focus on ambulatory hysteroscopy shilpa kolhe ambulatory gynaecology unit, royal derby hospital, derby, uk abstract. Chronic heavy or prolonged uterine bleeding can result in anemia, interfere with daily activities, and raise concerns about uterine cancer. Approach to diagnosis and management of abnormal uterine. Currently, there are no guidelines for comprehensive evaluation and management of dub, and most existing guidelines focus on narrow and specific etiology and age groups. Management of abnormal uterine bleeding in reproductive period. Ideally, this should be in a face to face consultation. Implementation of the guideline recommendations will improve the provision of ea as an effective treatment.
A systematic approach to aub evaluation can simplify management and enhance womens wellbeing. Endometrial ablation in the management of abnormal uterine. The patients perception of abnormal bleeding may be misleading and education about normality might be all that is necessary. Because of this complexity, concise guidelines have been dif. Evaluation and management of abnormal uterine bleeding in premenopausal women.
Abnormal uterine bleeding describes any variation from normal. Clinical practice clinical update dysfunctional uterine. This abnormal uterine bleeding generally can be divided into anovulatory and ovulatory patterns. Abnormal uterine bleeding with no evidence of mechanical or structural cause.
Chronic abnormal uterine bleeding aub, a term that refers to menstrual bleeding of abnormal quantity, duration, or schedule, is a common. Evidencedbased clinical medicine abnormal uterine bleeding. Abnormal uterine bleeding aub is a common but complicated clinical presentation. Abnormal uterine bleeding is a common problem, and its management can be complex. Bear in mind that abnormal uterine bleeding is a subjective complaint, and a detailed history is the key initial step in management. Abnormal uterine bleeding in reproductiveage women. Abnormal uterine bleeding aub is a common condition that leads to increased health care costs and decreased quality of life. The normal menstrual cycle lasts 28 7 days, the flow lasts 4 2 days, and the average blood loss is 40 20 ml. Abnormal uterine bleeding murtaghs general practice, 7e.
This system, approved by the international federation of gynecology and obstetrics, uses the term abnormal uterine bleeding paired with terms that describe associated bleeding patterns heavy menstrual bleeding or intermenstrual bleeding, a qualifying. Guideline committee on practice bulletinsgynecology. Overview of abnormal uterine bleeding in adolescents. Endometrial ablation in the management of abnormal uterine bleeding j obstet gynaecol can 2015. Pdf management of abnormal uterine bleeding focus on. Ppt abnormal uterine bleeding powerpoint presentation. Abnormal uterine bleeding aub is the main reason women are referred to gynecologists and accounts for two thirds of all hysterectomies. Abnormal uterine bleeding aub is any variance of the normal menstrual cycle, which is defined on the basis of four parameters frequency, regularity, duration, and volume.
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