dysfunctional uterine bleeding pdf

Gray R, 2013;368(2):128–137. Chronic anovulation syndrome and associated neoplasia. Endometrial dysfunction is poorly understood; there are no reliable diagnostic methods, and it should be considered only after other causes are excluded.5. 55. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Ray A. Menorrhagia I: measured blood loss, clinical features, and outcome in women with heavy periods: a survey with follow-up data. 43. Mikhail S, 5. 2011;29(5):389. 24. The FIGO recommendations on terminologies and definitions for normal and abnormal uterine bleeding. 2003;188(1):100–107. [2] Iron supplementation may be needed. Abnormal uterine bleeding is a common symptom in women. The prevalence of conditions that cause abnormal bleeding varies according to age. Dysfunctional uterine bleeding in premenopausal member with all of the following: – Abnormal bleeding uncontrolled by conservative therapy, such as hormonal therapy – No evidence of cancer demonstrated by hysteroscopy, endometrial biopsy, or dilation and curettage (D&C) – No detectable structural or anatomic cause for the bleeding Kouides PA, Munro MG, Clinical guideline [CG44]. Kafrissen M. Evatt B. : Agency for Healthcare Research and Quality; 2013. Wesley RM. Medical and surgical treatment options are available. Campbell N, Geburtshilfe Frauenheilkd. 45. Updated August 2016. https://www.nice.org.uk/guidance/cg44. Gaudoin M. Pinto A, 3 FIGO‐AUB SYSTEM 1 3.1 Revision of terminologies and definitions of symptoms of abnormal uterine bleeding. 557: management of acute abnormal uterine bleeding in nonpregnant reproductive-aged women. Abnormal uterine bleeding is the most common symptom of endometrial cancer.18 Although the prevalence of endometrial cancer increases with age, close to one-fourth of new diagnoses occur in patients younger than 55 years.19  Long-term unopposed estrogen exposure is the primary risk factor (Table 3).18,20 Bleeding patterns in patients with uterine malignancy are highly variable. Disturbances of menstruation in hypothyroidism. Differential diagnosis of genital tract bleeding in women. [3] Healthcare induced causes may include side effects of birth control. Prevalence, 1-year regression rate, and clinical significance of asymptomatic endometrial polyps: cross-sectional study. Basu R, Heliövaara-Peippo S, Obstet Gynecol. 557: management of acute abnormal uterine bleeding in nonpregnant reproductive-aged women. [3] In AUB underlying causes may be present. Wheeler TL II, Kouides P. The FIGO recommendations on terminologies and definitions for normal and abnormal uterine bleeding. Hurskainen R, Kranz JS. Hickey M, Baiocchi G, Want to use this article elsewhere? Irvine GA, Medical therapy (e.g., oral estrogen, combined oral contraceptives, oral progestins, intravenous tranexamic acid) is usually adequate for treating hemodynamically stable patients with severe bleeding. Won H, Multiple factors should be considered when choosing among treatment options for abnormal uterine bleeding (Table 4),37–42 including the cause and acuity of the bleeding, fertility and contraceptive preferences, medical comorbidities, adverse effects, cost, and relative effectiveness. Zacur HA. Hartmann KE, Jerome RN, Lindegren ML, et al. Madsen KP. More information on the diagnosis and management of endometrial cancer is available in a previous American Family Physician article (https://www.aafp.org/afp/2016/0315/p468.html). Marjoribanks J. Eur J Obstet Gynecol Reprod Biol.      Print. Blumenthal P, Mulder AB, Managing an episode of severe or prolonged uterine bleeding. 2003;188(2):343–348. Lethaby A, Menorrhagia I: measured blood loss, clinical features, and outcome in women with heavy periods: a survey with follow-up data. 28. Teperi J, High cumulative incidence of uterine leiomyoma in black and white women: ultrasound evidence. 2003;12(9):911–919. Douglas A, Hormonal contraception is the most common cause of iatrogenic uterine bleeding (i.e., breakthrough bleeding).5 Other causative agents include noncontraceptive hormone therapy, drugs that interfere with sex steroid hormone function or synthesis (e.g., tamoxifen), anticoagulants, and dopamine antagonists (e.g., tricyclic antidepressants, some antipsychotics). The FIGO recommendations on terminologies and definitions for normal and abnormal uterine bleeding. van der Zee AG, Managing an episode of severe or prolonged uterine bleeding. 52. ; Comparative effectiveness and impact on health-related quality of life of hysterectomy vs. levonorgestrel intra-uterine system for abnormal uterine bleeding. To see the full article, log in or purchase access. Coulam CB, Albers JR, Breech L; Clinical guideline [CG44]. 38. Conard J, Oriel KA, van der Zee AG, Heikkilä A, Lumsden MA, Am J Obstet Gynecol. Hereditary nonpolyposis colorectal cancer (Lynch syndrome), Type 2 diabetes mellitus, hypertension, gallbladder disease, or thyroid disease, Approximately 20% of patients with heavy menstrual bleeding have a bleeding disorder, and the prevalence in adolescent girls who bleed heavily is even higher.21–23 Von Willebrand disease and platelet dysfunction are the most common coagulopathies associated with abnormal uterine bleeding.24 In addition to heavy menstrual bleeding, adolescents with bleeding disorders may report irregular menstrual bleeding.25. Critchley HO, : Agency for Healthcare Research and Quality; 2013. Hull SK, Campbell N, [2] Ultrasound is specifically recommended in those over the age of 35 or those in whom bleeding continues despite initial treatment. Grimes DA. Blumenthal P, A variety of endocrine disorders can lead to ovulatory dysfunction (Table 2).9–11 Infrequent or absent ovulation during the first few years after menarche and during perimenopause is common and not necessarily a sign of underlying pathology.26 Menstrual bleeding caused by ovulatory dysfunction is often irregular, heavy, or prolonged. If the underlying cause of bleeding can be identified and treated, symptoms may resolve without the need for additional intervention. Critchley HO, Brisinger M, Although the uterus is often the source, any part of the female reproductive tract can result in vaginal bleeding. The FIGO recommendations on terminologies and definitions for normal and abnormal uterine bleeding. Lumsden MA, Accessed August 19, 2018. [3] Bleeding typically last less than nine days and blood loss is less than 80 mL. 2017;21(9):2255–2260. Hoffman BL, Schorge JO, Bradshaw KD, Halvorson LM, Schaffer JI, Corton MM. Hurskainen R, Primary care management of abnormal uterine bleeding. Walker JJ, Evaluation and management of abnormal uterine bleeding in premenopausal women. 48. Evaluation involves a detailed history and pelvic examination, as well as laboratory testing that includes a pregnancy test and complete blood count. 2010;16(1):9–11. Lukes A, Am J Obstet Gynecol. 25. Gray R, [1][3] Variation in the length of time between cycles is typically less than 21 days. Get Permissions, Access the latest issue of American Family Physician. ‡—Initial screening tests may be normal in the setting of some coagulopathies, with diagnosis requiring further testing and possibly hematology consultation. [2], Treatment depends on the underlying cause. Obstet Gynecol. Lukes AS; BRRB bright red rectal bleeding BS bowel sounds BSC bed side commode BSI body substance isolation BSO bilateral salpingo-oophorectomy BSS balanced salt solution BTBV beat to beat variability BTL bilateral tubal ligation ... DUB dysfunctional uterine bleeding DVI … Patients with severe bleeding can be treated initially with oral estrogen, high-dose estrogen-progestin oral contraceptives, oral progestins, or intravenous tranexamic acid. Mainor N, 30. J Minim Invasive Gynecol. Critchley HO, Fertil Steril. Oral medroxyprogesterone acetate and combination oral contraceptives for acute uterine bleeding: a randomized controlled trial. Reprints are not available from the authors. Information from references 9 through 11. All rights Reserved. Mikhail S, Am J Obstet Gynecol. / For hemodynamically unstable patients, uterine tamponade using a Foley catheter or gauze packing can achieve rapid but temporary control of blood loss.43 Further emergency interventions for hemodynamically unstable patients include intravenous estrogen, dilation and curettage, uterine artery embolization, and, rarely, hysterectomy. [4], The causes of AUB are divided into nine groups: uterine polyps, fibroids, adenomyosis, cancer, blood clotting disorders, problems with ovulation, endometrial problems, healthcare induced, and not yet classified. Munro MG, Oriel KA, Hemostasis and menstruation: appropriate investigation for underlying disorders of hemostasis in women with excessive menstrual bleeding. et al. 2007;10(3):183–194.... 2. Sullivan LM. 2010;23(6 suppl):S15–S21. Lumsden MA, Jain JK, Abnormal uterine bleeding. Information from references 37 through 42. National Institute for Health and Care Excellence. Data Sources: A PubMed search was completed in Clinical Queries using the key terms abnormal uterine bleeding, heavy menstrual bleeding, irregular menstrual bleeding, menorrhagia, metrorrhagia, and dysfunctional uterine bleeding. Salim S, 2012;85(1):35–43. Grimes DA. Download Free PDF. CNGOF Collège National des Gynécologues et Obstétriciens Français. Evaluation and management of abnormal uterine bleeding. Obstet Gynecol. UpToDate. Kaltsas T, Sabin CA, Cochrane Database Syst Rev. STOP-DUB Research Group. 2004;190(5):1216–1223. Contact Therefore, in the case of the patient with dysfunctional uterine bleeding, the diagnoses for both the E/M service and the endometrial biopsy would likely be the same. 2009;201(5):462.e1–462.e4. Marret H, Use of health services associated with increased menstrual loss in the United States. Hemostasis and menstruation: appropriate investigation for underlying disorders of hemostasis in women with excessive menstrual bleeding. Committee on Practice Bulletins—Gynecology. [3][2] Options may include hormonal birth control, gonadotropin-releasing hormone (GnRH) agonists, tranexamic acid, NSAIDs, and surgery such as endometrial ablation or hysterectomy. Doan QV, Heavy menstrual bleeding is defined as more than 80 mL of total blood loss, but quantitative assessment is impractical in routine clinical practice. Some evidence has associated ovulatory DUB with more fragile blood vessels in the uterus.It may represent a possible endocrine dysfunction, resulting in menorrhagia or metrorrhagia. Manci N, Menstrual bleeding patterns and prevalence of bleeding disorders in a multidisciplinary adolescent haematology clinic. Schectman JM. Lethaby A, Triphasic norg-estimate-ethinyl estradiol for treating dysfunctional uterine bleeding. Annegers JF, Arias RD, Douglas A, Usually, however, the mechanisms are unknown. 1998;105(6):592–598. Gaudoin M. Schrager S. Changes in bleeding patterns with depot medroxyprogesterone acetate subcutaneous injection 104 mg. Contraception. These etiologies are not mutually exclusive, and patients may have more than one cause. Am Fam Physician. Comparative effectiveness and impact on health-related quality of life of hysterectomy vs. levonorgestrel intra-uterine system for abnormal uterine bleeding. In other situations, the visit might be prompted by … Copyright © 2020 American Academy of Family Physicians. Abnormal uterine bleeding is a common condition, with a prevalence of 10% to 30% among women of reproductive age.1 It negatively affects quality of life and is associated with financial loss, decreased productivity, poor health, and increased use of health care resources.2–4 In 2011 the International Federation of Gynecology and Obstetrics convened a working group that produced standardized definitions and classifications for menstrual disorders, which the American College of Obstetricians and Gynecologists subsequently endorsed.5,6 The updated terminology pertains only to nonpregnant women of reproductive age, which is the scope of this review. Rees MC. Sandvik L, Penninx J, Comparative effectiveness review no. Daniels J, Jacobs P, 41. / afp Warner PE, Rockville, Md. Clark MA, Kluin-Nelemans HC, Hysterectomy is the most effective treatment for reducing heavy menstrual bleeding. Br J Obstet Gynaecol. Kouides PA, [1][5] Polyps, adenomyosis, and cancer are generally treated by surgery. Bradley LD, 2006;74(3):234–238. Critchley HO, Triphasic norg-estimate-ethinyl estradiol for treating dysfunctional uterine bleeding. Schrager S. Levonorgestrel intrauterine system versus medical therapy for menorrhagia. Ahuja SP, Womens Health Issues. The 20-mcg-per-day formulation of the levonorgestrel-releasing intrauterine system (Mirena) is more effective than other medical therapies for reducing heavy menstrual bleeding. [3][2] Options may include hormonal birth control, gonadotropin-releasing hormone (GnRH) agonists, tranexamic acid, NSAIDs, and surgery such as endometrial ablation or hysterectomy. Kadir R. Hertweck SP. Davis A, [3] More than one category of causes may apply in an individual case. [6], More extensive testing might include an MRI and endometrial sampling. Broder M, Its prevalence ranges from 5% to 70%, and its association with abnormal uterine bleeding is unclear.15 Many patients are asymptomatic, but those who have symptoms typically report painful, heavy, or prolonged menstrual bleeding. Munro MG, Côté I, Braverman PK, Levonorgestrel intrauterine system versus medical therapy for menorrhagia. [3] Iron deficiency anemia may occur and quality of life may be negatively affected. READ PAPER. A systematic review evaluating health-related quality of life, work impairment, and health-care costs and utilization in abnormal uterine bleeding. [3] Vaginal bleeding during pregnancy is excluded. Brucker C, et al. Cancer stat facts: uterine cancer. Garry R, 54. 32. 29. [citation needed], The cause can be psychological stress, weight (obesity, anorexia, or a rapid change), exercise, endocrinopathy, neoplasm, drugs, or it may be otherwise unknown. Obstet Gynecol. 6. 51. Practice bulletin no. American Academy of Pediatrics. 12. Hertz-Picciotto I, Sweet MG, Garry R, [2], The underlying causes may include ovulation problems, fibroids, the lining of the uterus growing into the uterine wall, uterine polyps, underlying bleeding problems, side effects from birth control, or cancer. Financial and quality-of-life burden of dysfunctional uterine bleeding among women agreeing to obtain surgical treatment. Ross D, Committee on Practice Bulletins—Gynecology. Dubois RW. Lumsden MA, This content is owned by the AAFP. O'Brien SH. Qvigstad E. 2006;108(4):924–929. Campbell-Brown MB, This category contains poorly understood conditions, rare disorders (e.g., arteriovenous malformations), and conditions that do not otherwise fit into the classification system, such as cesarean scar defects, which can cause postmenstrual spotting when blood collects in the niche caused by the scar. Leiomyomas (also called fibroids) are benign tumors arising from the uterine myometrium. Hartmann KE, Jerome RN, Lindegren ML, et al. Don't miss a single issue. Mulder AB, Krassas GE,

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