By ULY CLINIC
Abnormal Uterine Bleeding in Pre-Menopausal Women
Introduction
Abnormal uterine bleeding (AUB) is a common condition affecting womenof reproductive age that has significant social and economic impact. Pre-menopausal abnormal uterine bleeding can be ovulatory, anovulatory, or anatomic
Diagnostic Criteria
Ovulatory might be associated with
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Premenstrual symptoms
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Dysmenorrhea
Anovulatory
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Irregular bleeding, often heavy
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endometrial hyperplasia
Anatomic
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Fibroids, polyps, or adenomyosis
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Often heavy bleeding, pain
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Uterus might be enlarged
Investigations
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A complete blood count (CBC)
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Pregnancy test
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Cervical and vaginal swab
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Ultrasound
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Testing for coagulation disorders should be considered only in women who have a history of heavy menstrual bleeding beginning at menarche or who have a personal or family history of abnormal bleeding
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Other investigations might be done on the basis of clinical suspicions
Pharmacological Treatment
The treatment will depend of the causative factor.
Mefenamic acid (250 mg)
OR
Ibuprofen (200–400 mg)1–2 tablets before or at beginning of menses, then 1 tablet every 6–8 hours for 5days
Tranexamic acid (500 mg–1000 mg every 6–8 hours as required
Combined oral contraceptives:
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Useful for anovulatory bleeding, might have benefit for ovulatory bleeding
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Medroxyprogesterone acetate (5–10 mg/d for 10–14 days initially and repeated for 10 days each month thereafter
Note
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AUB in the adolescent most commonly represents ovulatory dysfunction related to immaturity of the hypothalamic-pituitary-ovarian axis
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Selection of a medical therapy for AUB in adolescents should consider the need for contraception. Long acting reversible contraception may be considered first line therapy for both sexually active adolescents and, with individualized counseling, non-sexually active adolescents
Surgical management
AUB not responding to medical treatment may be due to intracavitary lesions such as submucosal fibroids. AUB secondary to submucosal fibroids may be managed by hysteroscopy myomectomy.
Updated on, 3.11.2020
References
1. STG