Abnormal uterine bleeding (the old dysfunctional uterine bleeding): How to manage?
Carlos Simón, Linda C. Giudice in The Endometrial Factor, 2017
Dysfunctional uterine bleeding is an outmoded term and should be discarded. Instead, those women with AUB with a structurally normal uterus and absence of iatrogenic cause should be reclassified under the AUB subcategories of coagulopathy (AUB-C), ovulatory (AUB-O), and endometrial (AUB-E) origin. The latter (AUB-E) is predominantly a diagnosis of exclusion. Careful history, examination, and targeted investigations are critical to ensure appropriate diagnosis and subsequent treatment options. In particular, it is important not to overlook the presence of a coagulopathy. Management options should be patient centered and encompass the contraceptive and fertility needs of each woman. The LNG-IUS has the greatest evidence base for current medical treatment, but patient satisfaction may still be higher with surgical intervention. However, hysterectomy, while definitive, continues to have the potential for serious complications. As such, there is a pressing need for effective and acceptable medical treatment options for women with menstrual bleeding complaints.
Gynaecology
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie in Bailey & Love's Short Practice of Surgery, 2018
Menstrual bleeding may be excessively heavy, irregular or frequent in the absence of pathology; this is known as dysfunctional uterine bleeding. The UK’s National Institute for Health and Care Excellence (NICE) has suggested a three- step hierarchal treatment approach to the management of heavy menstrual bleeding: (1) medical therapy; (2) minimally invasive uterus-conserving surgey; (3) major surgical procedures. The management plans are individualised for the patient, taking into account the concomitant symptoms and fertility requirements. Medical treatments used to reduce the amount of menstrual blood loss include tranexamic acid, mefenamic acid and the combined or progestin-only oral contraceptive pill (COCP or POP, respectively). It may be necessary to stop the bleeding completely using high-dose progestagens, the COCP taken continuously or a gonadotrophin-releasing hormone (GnRH) analogue with or without add-back hormone replacement therapy (HRT), which induces a menopause-like state. Increasingly, an intrauterine system (IUS) similar to a conventional coil, which releases levonorgestrel, is offered to patients as an alternative; it has the added advantage of being a reliable long-acting reversible contraceptive (up to 5 years). After 1 year of usage, there is a 71-95% reduction in menstrual blood loss with approximately 50% of women becoming amenorrhoeic.
Examination A
Aalia Khan, Ramsey Jabbour, Almas Rehman in The New DRCOG Examination, 2017
Primary amenorrhoea is failure to start menstruation by 16 years of age or 14 years of age if no breast development. Primary amenorrhoea can be caused by Turner’s syndrome, cryptomenorrhoea, and Mullerian agenesis. Secondary amenorrhoea is defined as absence of periods for more than six months when not pregnant. NICE guidelines 2007 define menorrhagia as excessive menstrual loss interfering with either one of a female’s physical, emotional, social or material quality of life (i.e. defined by the patient herself rather than quantitatively). Dysfunctional uterine bleeding is a diagnosis of exclusion and defined as heavy or irregular bleeding in the absence of recognizable pathology.
Anterior abdominal wall parasitic leiomyoma: case report
Published in Gynecological Endocrinology, 2018
María Fernanda Garrido Oyarzún, Adela Saco, Camil Castelo-Branco
A 53 years old woman, multiparous of one, presented at our clinic for a gynecological evaluation with persistent compressive pelvic symptoms, mainly vesical tenesmus, high urinary frequency of small volumes (urination every 2 h), moderate stress urinary incontinence, rectal tenesmus and postprandial abdominal distention. The menstrual cycles were regular with occasional dysmenorrhea and no abnormal uterine bleeding. She had been using an intrauterine device for birth control over the past 7 years. She had no previous abdominal surgeries or other relevant medical data. Speculum examination showed a normal cervix and no vaginal bleeding or discharge. Pelvic examination revealed an irregular palpable mass occupying the pelvis to the level of the umbilicus, and another mass of 5 cm in the Douglas. Both masses were slightly painful during manual mobilization and appear to explain the compressive symptomatology. Results of laboratory examinations were normal.
Current approaches to overcome the side effects of GnRH analogs in the treatment of patients with uterine fibroids
Published in Expert Opinion on Drug Safety, 2022
Mohamed Ali, Mohamed Raslan, Michał Ciebiera, Kornelia Zaręba, Ayman Al-Hendy
Uterine fibroids (UFs, AKA leiomyoma) are currently the most common benign tumors in the reproductive age women. Their incidence increases during the reproductive age to reach even 60–70% in the perimenopausal population [1,2]. Uterine fibroids may be solitary, but very often several of them or conglomerate masses are observed. The vast majority of those lesions do not produce any manifestations, but in approximately 30% of cases, they may contribute to a whole range of disorders. UF-triggered manifestations may be grossly divided into three main groups, i.e. symptoms associated with abnormal bleeding from the reproductive tract, those related to the presence of a pathological mass in the minor pelvic cavity and/or abdominal cavity, and ones related to reproductive dysfunctions [3,4]. Abnormal uterine bleeding, which seems to be the most common manifestation, may occur in a variety of forms, from spotting, through prolonged menorrhagia, to life-threatening hemorrhages, which cause severe anemia. Bleeding problems occur most commonly in patients with fibroids adjacent to the endometrium, but lesions located nearby may also disrupt the bleeding pattern [5]. It is due to the fact that UFs are also biologically active tissues that influence the endometrium in a paracrine manner [6,7].
The effect of adenomyosis on endometrial cancer: a university hospital-based cohort study
Published in Journal of Obstetrics and Gynaecology, 2022
Engin Celik, Hale Goksever Celik, Hamdullah Sozen, Semen Onder, Ozgur Aydin Tosun, Samet Topuz, Mehmet Yavuz Salihoglu
As one of our main results, we found that EC in women with adenomyosis had less invasive features. The main reason why EC is diagnosed at a less advanced stage in these patients is that women with adenomyosis consult the clinics due to their adenomyosis-related complaints, especially in premenopausal period (Nelsen et al. 2018). These symptoms are usually abnormal uterine bleeding, and lower abdominal pain or discomfort. On the other hand, the diagnosis of EC in the patients without adenomyosis is usually due to postmenopausal bleeding at an older age. Although there was no statistical significance, the patients in the adenomyosis group were also younger comparing with those in the non-adenomyosis group in our study. Furthermore, only follow-up without the need for additional treatments was adequate for the postoperative follow-up of EC in the patients with adenomyosis due to the detection of EC at earlier stages.
Related Knowledge Centers
- Adenomyosis
- Endometrial Polyp
- Ovulation
- Quality of Life
- Uterine Fibroid
- Uterus
- Vaginal Bleeding
- Heavy Menstrual Bleeding
- Obstetrical Bleeding
- Iron-Deficiency Anemia
- Quality of Life