{"paper_id":"0ddbde82-4cc8-45e9-95f3-5d9a3b7ceb3d","body_text":"~ 1359 ~ \nInternational Journal of Clinical Obstetrics and Gynaecology 2025; 9(6): 1359-1364 \n \nISSN (P): 2522-6614 \nISSN (E): 2522-6622 \nIndexing: Embase \nImpact Factor (RJIF): 6.71 \n© Gynaecology Journal \nwww.gynaecologyjournal.com \n2025; 9(6): 1359-1364 \nReceived: 22-10-2025 \nAccepted: 26-11-2025 \n \nDr. Harika G \nSenior Resident, Department of \nObstetrics and Gynecology, \nNiloufer Hospital/Osmania Medical \nCollege, Koti, Telangana, India \n \nDr. A Anitha \nAssociate Professor, Department of \nObstetrics and Gynecology, \nGovernment Medical College, \nSangareddy, Telangana, India \n \nDr. Gaddam Shamili \nAssistant Professor, Department of \nObstetrics and Gynaecology, \nGovernment Medical College, \nSangareddy, Telangana, India \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \nCorresponding Author: \nDr. A Anitha \nAssociate Professor, Department of \nObstetrics and Gynecology, \nGovernment Medical College, \nSangareddy, Telangana, India \n \nA study on abnormal uterine bleeding and its management \nin reproductive age women in tertiary care hospital \n \nHarika G, A Anitha and Gaddam Shamili \n \nDOI: https://www.doi.org/10.33545/gynae.2025.v9.i6h.1801  \n \nAbstract \nBackground: Abnormal Uterine Bleeding (AUB) is a common gynaecological complaint in reproductive -\nage women and requires systematic evaluation. The FIGO PALM -COEIN classification provides a \nstandardized framework for diagnosing and managing AUB. \nObjectives: To classify reproductive-age women with AUB according to the FIGO PALM-COEIN system \nand to establish individualized management protocols for each etiological group. \nMethods: This observational study was conducted on 200 women attending the Gynaecology Outpatient \nDepartment at Modern Government Mate rnity Hospital, Petlaburz, Hyderabad. Detailed history, clinical \nexamination, and laboratory investigations were performed for all participants. Endometrial samples were \nobtained through dilatation and curettage under aseptic precautions and evaluated hist opathologically. \nMedical management included mefenamic acid, tranexamic acid (500 mg TID during menstruation), \nnorethindrone acetate (5 -10 mg, days 5 -25), combined oral contraceptives, and levonorgestrel -releasing \nintrauterine system (LNG-IUS). Surgical management was provided where indicated. \nResults: The majority of participants were aged 40 -44 years (57%) and were predominantly multiparous. \nHeavy menstrual bleeding was the most common presenting pattern (69%). Proliferative endometrium was \nthe most frequent histopathological finding. Hormonal therapy along with tranexamic acid and mefenamic \nacid demonstrated good efficacy in controlling AUB. Surgical interventions included hysterectomy in \n78.5% of hyperplasia/malignancy cases, 45.7% of leiomyoma cases, an d 20% of adenomyosis cases. \nMyomectomy was performed in 11.4% of leiomyoma cases. LNG -IUS was effective in 60% of \nadenomyosis patients. \nConclusion: The FIGO PALM -COEIN system proved effective in classifying AUB and guiding targeted \nmanagement. Most women r esponded well to medical therapy, while surgical treatment was reserved for \nstructural causes and refractory cases. Tailored management based on classification improves outcomes \nand reduces unnecessary interventions. \n \nKeywords: Abnormal Uterine Bleeding (A UB), proliferative endometrium, leiomyoma, adenomyosis, \nendometrial hyperplasia, hysterectomy \n \nIntroduction \nAbnormal Uterine Bleeding (AUB) is a common condition affecting the women of reproductive age that \nhas a significant social and economic impact. It has a negative impact on women’s health and well -being \nincluding anemia, absenteeism and social embarrassment. It occurs in 9 -14% of women between menarche \nand menopause, significantly impacting quality of life and imposing financial burden [1, 2].  \nAUB may be defined as any variation from the normal menstrual cycle, and includes changes in regularity \nand frequency of menses, in duration of flow, or in amount of blood loss. Under category of AUB further \ndefinitions may be subdivided based on volume of menst ruation, regularity, frequency, duration, flow and \ntiming related to reproductive status. \nThe most frequent cause of irregular bleeding in the reproductive age group is hormonal, although other \ncauses such as pregnancy related bleeding (spontaneous abortio n, ectopic pregnancy) should always be \nconsidered. History and physical examination will help to establish the cause of the abnormal bleeding, to \ndirect further investigations, and to guide options for management [3, 4]. \nThe International Federation of Gyn aecology and Obstetrics in November 2010 accepted a new \nclassification system for causes of AUB in the reproductive years. The system based on the acronym \nPALM-COEIN (polyps, adenomyosis, leiomyoma, malignancy and hyperplasia, coagulopathy, ovulatory \ndisorders, endometrial causes, iatrogenic, not classified) was developed in response to concerns about the \ndesign and interpretation of basic science and clinical investigation that relates to the problem of AUB.  \n \nMaterials and Methods  \n200 cases of AUB were selected from patients who report to outpatient department, at department of  \n\n\nInternational Journal of Clinical Obstetrics and Gynaecology https://www.gynaecologyjournal.com \n~ 1360 ~ \nobstetrics and gynaecology, modern government maternity \nHospital, Petlaburz, Hyderabad, Telangana from December 2020 \nto November 2022.  \n \nMethods for collection of data \n Design of study: This an observational study. \n Duration of the study: From December 2020 to November \n2022. \n Sample size: 200 cases who full filled the inclusion criteria. \n Inclusion Criteria: Women aged 20 -44 with Clinical \nevidence of AUB. \n Exclusion Criteria:  Bleeding caused by pregnancy and \npregnancy related factors, Puberty menorrhagia and \nPerimenopausal bleeding. \n History: A careful current menstrual history of  Cycle \nlength, duration of flow in days and amount of bleeding in \neach period -scanty/moderate/heavy, Assessm ent made on \nsubjective experience of patients number of pads used pe r \nday, history of passing clots . Associated with lower \nabdominal pain. History of amenorrhea before the onset of \nbleeding and last menstrual period.  History of \nintermenstrual bleeding and history of past menstrual \ncycles, obstetric history, history of comorbid conditions, \nany history of previous surgeries and history of previous \nmedications, family history. After detailed history, thorough \nphysical and pelvic examinations was done and patie nts \nwere sent for investigations. \n \nInvestigations as  Blood grouping and typing,  Complete blood \ncount, Bleeding time and Clotting time, Coagulation profile, \nThyroid profile, Random blood sugar and Ultrasound abdomen \nand pelvis. \nAfter thorough history, clini cal examination and investigations, \nthe diagnosis of AUB was established. Endometrial biopsy was \ntaken for all patients using dilatation and curettage under aseptic \nprecautions. Samples were sent for histopathological \nexamination. Women were given Tab Mefe namic acid and \nTranexamic acid 500mg TID during menstruation, after \nevaluation some of them were treated by medical management \nusing Norethindrone acetate 5 -10mg daily from 5 th-25th day, \nLevonorgestrel, Releasing Intrauterine System Low dose COC \npills, Some were treated by surgical management. \n \nResults  \nThe true incidence of AUB is difficult to establish because most \npatients are treated on OPD basis and the normal variation in \nmenstrual cycle during the transition phase may be considered as \nabnormal bleeding by the patient. \n \nTable 1: Prevalence according to PALM-COEIN Classification \n \nPALM-COEIN Classification Number of cases Percentage \nP Polyp 20 10 \nA Adenomyosis 20 10 \nL Leiomyoma 70 35 \nM Hyperplasia & G Malignancy 14 7 \nC Coagulopathy 0 0 \nO Ovulatory dysfunction 72 36 \nE Endometrial 4 2 \nI Iatrogenic 0 0 \nN Not classified 0 0 \n \nOut of 200 cases, maximum cases had AUB due to Ovulatory \nDysfunction (36%), followed by Leiomyoma (35%), \nAdenomyosis (10%), Polyp (10%), Malignancy and Hyperplasia \n(7%), Endometrial (2%). No cases of Coagulopathy, Iatrogenic \nand Not classified was found. \n \nTable 2: Distribution of age in study group \n \nAge Number Percentage \n20-24 11 5.5% \n25-29 8 4% \n30-34 12 6% \n35-39 55 28.5% \n40-44 114 57% \n \nIn our study majority of age group we re found to be between 40 \nto 44 years (57%), followed by 35 to 39 years age group \n(28.5%), followed by 30 to 34 years (6%), followed by 20 to 24 \nyears age group (5.5%) and 25 to 29 years age group (4%) \nrespectively. \n \nTable 3: Correlation between age and PALM-COEIN Classification \n \n P A L M O E Total \n20-24 0 0 0 0 11 0 11 \n25-29 1 1 2 0 3 1 8 \n30-34 0 1 2 0 8 1 12 \n35-39 7 5 21 5 15 2 55 \n40-44 12 13 45 9 35 0 114 \nTotal 20 20 70 14 72 4 200 \nP=0.053  \n \nIn our study, most common cause for AUB in 20 -24 year ag e \ngroup was AUB -O, in 25 -29 year age was AUB -O, in 30 -34 \nyear age group was AUB-O, in 35-39 year age group was AUB -\nL, in 40 -44 year age group was AUB -L. Most common age of \npresentation for all structural causes of AUB was 40 -44 years, \nwhereas non -structural causes, for AUB -O was 40 -45 years, \nAUB-E was 35 -39 years. As p>0.05, it is not statistically \nsignificant. \n \nTable 4: Distribution of parity in study group \n \nParity Number Percentage \nNullipara 13 6.5% \nPrimipara 23 11.5% \nMultipara 136 68% \nGrand multipara 28 14% \n \nIn our study, multipara woman were more i.e. 68%, which is \nfollowed by grand multipara woman (14%) followed by \nPrimipara (11.5%) and Nullipara (6.5%) woman respectively. \n \nTable 5: Distribution of bleeding pattern in study group \n \nBleeding patterns Bleeding pattern Percent \nHeavy menstrual bleeding 138 69.0 \nInter menstrual bleeding 12 6.0 \nProlonged bleeding 27 13.5 \nFrequent menstrual bleeding 18 9.0 \nInfrequent menstrual bleeding 5 2.5 \nTotal 200 100.0 \n \nHeavy menstrual bleeding was the most comm on symptom \naccounting for 69% followed by prolonged bleeding 13.5% and \nleast being infrequent menstrual bleeding 2.5%. \nMost common bleeding pattern in Polyp was with heavy \nmenstrual bleeding (65%). The most common bleeding pattern \nin Adenomyosis was heavy menstrual bleeding (80%). The most \ncommon bleeding pattern in Leiomyoma was Heavy menstrual \n\nInternational Journal of Clinical Obstetrics and Gynaecology https://www.gynaecologyjournal.com \n~ 1361 ~ \nbleeding (65.7%). The most common bleeding pattern in \nMalignancy and Hyperplasia was Heavy menstrual bleeding \n(64.2%). The most common bleeding pattern in Ovulatory  \nDysfunction was heavy menstrual bleeding (69.4%). The most \ncommon bleeding pattern in Endometrial was heavy menstrual \nbleeding (100%). As the p<0.05, it is statistically significant.  \n \nTable 6: Correlation of bleeding pattern & cause \n \nCause Bleeding Pattern Total Heavy Menstrual bleeding Inter menstrual Bleeding Prolonged bleeding Frequent Menstrual bleeding Infrequent \nPolyp 13 7 - - - 20 \nAdenomyosis 16 1 2 1 - 20 \nLeiomyoma 46 3 8 9 4 70 \nMalignancy and Hyperplasia 9 1 4 - - 14 \nOvulatory Dysfunction 50 - 13 8 1 72 \nEndometrial 4 - - - - 4 \nTotal 138 12 27 18 5 200 \nP=0.004 \n \nTable 7: Correlation of histopathology and PALM-COEIN Classification \n \nCause Histopathology Total Proliferative Secretory Endometrial hyperplasia EIN Carcinoma \nPolyp 15 5 0 0 0 20 \nAdenomyosis 19 1 0 0 0 20 \nLeiomyoma 65 5 0 0 0 70 \nHyperplasia & G Malignancy 0 0 11 2 1 14 \nCoagulopathy 0 0 0 0 0 0 \nOvulatory dysfunction 67 5 0 0 0 72 \nEndometrial 4 0 0 0 0 4 \nIatrogenic 0 0 0 0 0 0 \nNot classified 0 0 0 0 0 0 \nTotal 170 16 11 2 1 200 \nP=0.0023 \n \nOut of 72 cases of Ovulatory Dysfunction, 67(93%) cases were \nproliferative followe d by 5(7%) cases secretory. Out of 70 \nleiomyoma cases, 65(92.8%) were proliferative type of \nendometrium, followed by 5(7.2%) secretory. Out of 20 cases of \nPolyp, 15(75%) were proliferative, followed by 5(25%) cases \nsecretory. Out of 20 cases of Adenomyosis , 19(95%) were \nproliferative, 1(5%) was secretory. Out of 14 cases of AUB -M, \n11 cases of endometrial hyperplasia, 2 cases of EIN and 1 case \nof endometrial carcinoma were present. 4(100%) cases of AUB -\nE were proliferative. As p<0.05, it is statistically significant.  \n \n \n \nFig 1: Treatment in patients of study \n \n86(43%) women were given progestins either oral (71) or LNG -\nIUS (15), 11 cases (5.5%) received COC pills, 4(2%) cases \nreceived GnRH agonist injection & 24(12%) cases were given \ntranexamic acid along wit h mefenamic acid. Total 125(62.5%) \ncases were managed medically. 75(37.5%) cases were managed \nsurgically. Out of which 46(23%) underwent Total Abdominal \nHysterectomy, 20(10%) underwent polypectomy, 8(4%) \nunderwent Myomectomy & 1(0.5%) underwent Radical \nHysterectomy. As p<0.05, it is statistically significant. \n \nTable 8: Management of cases in present study \n \nPolyp Cases \nPolypectomy 20 \nAdenomyosis  Progestins 16(80%) \nTAH 4(20%) \nTotal 20 \nLeiomyoma  \nProgestins 16(22.8%) \nCOC pills 10(14.2%) \nGnRH agonist 4(5.7%) \nMyomectomy 8(11.4%) \nTAH 32(45.9%) \nTotal 70 \nMalignancy and Hyperplasia  \nProgestins 3(21.4%) \nTAH 10(71.4%) \nRadical hysterectomy 1(7.2%) \nTotal 14 \nOvulatory Dysfunction  \nProgestins 48(66.6%) \nTranexamic +Mefenamic Acid 24(33.4%) \nTotal 72 \nAUB-E  \nProgestins 3 \nCOC pills 1 \nTotal 4 \n \nAll cases of polyp underwent polypectomy. 38 Out of 20 cases, \n16(80%) cases were treated with progestins, oral (4), LNG -IUS \n(12), 4 (20%) cases underwent TAH. Out of 70 cases of \nLeiomyoma, 32(45.9%) cases underwent TAH, 16(22.8%) cases \n\nInternational Journal of Clinical Obstetrics and Gynaecology https://www.gynaecologyjournal.com \n~ 1362 ~ \nwere treated with Progestins (oral), 10(14.2%) cases were \ntreated with COC pills, 4(5.7%) cases were treated with GnRH \nagonist & 8(11.4%) cases underwent Myomectomy. Out of 14 \ncases of Malignancy and Hyperplasia, 10(71.4%) cases \nunderwent TAH, 3(21.4%) cases were treated with Progestins \n(LNG-IUS) & 1(7.2%) underwent Radical Hysterectomy. Out of \n72 cases, 48(66.6%) cases were treated with Progestins (oral), \n24(33.4%) cases were treated with Tranexamic + Mefenamic \nacid. And underlying i dentified cause was treated. Out of the 4 \ncases, 3(75%) cases were treated with Progestins and 1(25%) \ncases were treated with COC pills. \n \nTable 9: Age-wise distribution and indications of Hysterectomy cases \n \nAge No of hysterectomy cases Percentage \n20-24 0 - \n25-29 0 - \n30-34 0 - \n35-39 3 6.5% \n40-44 43 93.5% \nIndications   Leiomyoma 32 69.5% \nMalignancy and Hyperplasia 10 21.7% \nAdenomyosis 4 8.8% \n \nOut of 46 hysterectomy cases, 3 cases (6.5%) were in age group \nof 35 to 39 years, 43 cases (93.5%) were in age group of 40 to \n44 years. Out of 46 cases of hysterectomy, 32(69.5%) cases \nwere of Leiomyoma, 10(21.7%) cases were of Malignancy and \nHyperplasia and 4(8.8%) cases were of Adenomyosis. \n \nDiscussion  \nThe present study was conducted in Department of Obstetr ics \nand Gynaecology, Modern Government Maternity Hospital, \nPeltaburz from the year December 2020 to November 2022 on \n200 patients of AUB attended to Gynaecology OPD. Prevalence \nof Adenomyosis (10%) and AUB -E (2%) was comparable to \nSingh PB, et al . [5] study i.e., 13.5% and 4% respectively. \nPrevalence of Polyps (10%), Leiomyoma (35%) and Malignancy \nand Hyperplasia (7%) was more than Singh PB et al. [5] study. \nWhereas prevalence of Ovulatory Dysfunction (36%) was less \ncompared to Singh PB, et al. [5] 5 study.  \nIn present study 9.5% were in age group of 21 -30years, which is \nsimilar with results of studies by Muzaffar et al. [6], Saraswathi \net al. [7] which range from 11.5% to 20.8%, respectively. 33.5% \nwere in age group of 31 -40 years, which is in concordance w ith \nresults of Muzaffar, et al  [6] (39.2%) and Singh PB, et al . [5] \n(31.8%).  \nAbnormal uterine bleeding is the most frequent complaint seen \nin patients attending outpatient department. Majority of cases of \nAUB are seen age group 40 -44 years (57%), this mig ht be \nbecause of decline in ovarian function with more anovulatory \ncycles and hyperestrogenism. On looking at age distribution of \nvarious causes of AUB, cause of AUB in age group 20 -24 years \nwas Ovulatory Dysfunction (100%). AUB-O is more common in \nthis ag e group mostly because of ovulatory dysfunction \novulation in extremes of age. Approximately 90% of uterine \nbleeding due to Ovulatory Dysfunction result from anovulation, \nand 10% of cases occur with ovulatory cycles. The reason \nbehind this irregular bleedin g is due to dysfunction of \nHypothalamic Pituitary (HPO) axis. Failure of ovulation leads to \nabsence of corpus luteum formation and no secretion of \nprogesterone, causing unopposed estrogen effect on \nendometrium. Estrogen causes unopposed endometrial \nproliferation manifesting as breakthrough bleeding. The major \nfactors affecting HPO axis are polycystic ovarian syndrome, \nthyroid disorders and hyperprolactinemia, other factors are \nobesity, anorexia, mental stress.  \n \nTable 9: Parity wise distribution in AUB \n \nParity Lotha et al. [8] \n(%) \nSadia Khan [9] \n(%) \nPresent Study \n(%) \nNulliparous 6.1 5.4 6.5 \nPrimiparous 10.8 - 11.5 \nMultiparous 64.9 54 63 \nGrand multiparous 18.2 35.6 14 \n \nIn present study, nulliparous, primiparous, multiparous, \ngrandmultiparous were compara ble to Lotha et al . [8] and \nSadiaKhan et al. [9] study.  \nIn the present study most common bleeding pattern was heavy \nmenstrual bleeding (69%) and least common was infrequent \nmenstrual bleeding (2.5%). In the present study, bleeding \npatterns like heavy mens trual bleeding were comparable \nwhereas, intermenstrual bleeding and frequent menstrual \nbleeding was less. We observed prolonged bleeding in 13.5% \ncases and oligomenorrhoea in 2.5% cases which were nil in Dr. \nKusum [10] study. \n \nTable 10: Comparison of correlation of bleeding pattern & cause \n \n \nMost common \nbleeding pattern \nPresent study \n(%) Comparative study (%) \nP HMB 65 40 (Singh PB et al.) [5] \nA HMB 80 66.7 (Singh PB et al.) [5] \nL HMB 65.7 51 (Sun et al.) [11] \nM HMB 64.2 59.3 (Yelmaz et al.) [12] \nO HMB 69.4 61.4 (Singh PB et al.) [5] \nE HMB 100 80 (Singh PB et al.) [5] \n \nThe percentage of patients who presented with HMB was \ncomparable to present study and Yelmaz et al. [12] for AUB-M \nand AUB -O. Whereas in other causes percentage of patients \nwith HMB was more in present study than others.  \nThe cause of abnormal uterine bleeding in different etiologies is \ndifferent. In Polyp, it may be due to stromal congestion within \nthe polyp leading to venous stasis and apical necrosis. In \nAdenomyosis, it may be due to increased uterine volume causing \nincreased uterine surface area and possibly affecting normal \nmyometrial contractility. In Leiomyoma, symptoms depend on \nlocation and size of fibroids. AUB may be due to increase in \nendometrial surface area, presence of engor ged vasculature in \nperimyoma environment. In Malignancy and Hyperplasia, it may \nbe due to hyperplasia of endometrium. In Ovulatory \nDysfunction, it may be due to unopposed estrogen acting on \nendometrium. In Endometrial, it may be due to dysfunction of \nlocal endometrial hemostasis, likely deficiency in \nvasoconstriction (endothelin -1, prostaglandin F2a) and more \nproduction of plasminogen leading to increased lysis of clot.  In \npresent study, endometrial histopathological patterns like \nendometrial hyperplasia an d Carcinoma were comparable. \nWhereas, proliferative type of endometrium was found to be \nmore i.e. 85% and secretory type was found to be less 8% as \ncompared to Nadia et al . [13] study. The most common \nhistopathological pattern of endometrium was proliferat ive type \nin Polyp (75%), Adenomyosis (95%), Leiomyoma (92.8%), and \novulatory Dysfunction (93%) AUB-E (100%) in present study.  \nThe cause of AUB in present study is diagnosed by patient’s \nhistory, examination, investigations, by endometrial biopsy with \nD&C, transvaginal and transabdominal ultrasonography and \n\nInternational Journal of Clinical Obstetrics and Gynaecology https://www.gynaecologyjournal.com \n~ 1363 ~ \nPAP smear.  In the present study, 62.5% were managed \nmedically. In the present study 37.5% were managed surgically. \nHowever, in study by Coulter et al. [14], 54% of woman needed \nsurgery by one year. Hyste rectomy remains an alternative when \nconservative treatment fail. \n \nTable 11: Comparison of indications of hysterectomy \n \nIndication for \nHysterectomy \nChanderdeep et \nal. [15] 2014 (%) \nDr. K Indira \nSurya Kumari \net al. [1] (%) \nPresent Study \nNo (%) \nLeiomyoma 50.3 57 69.5 \nHyperplasia & \nMalignancy 15.3 5 21.9 \nAdenomyosis 14.7 5 8.6 \n \nThis table shows the indications for hysterectomy. In the present \nstudy most common cause for hysterectomies in AUB is \nLeiomyoma (69.5%) which is more compared to Chandradeep et \nal. [15], Dr. K Indira Surya Kumari et al . [1] 1 where the most \ncommon indication was also fibroid (50.3%) and (57%) \nrespectively. \n \nManagement of Polyps  \nRisk factors for polyps are age, tamoxifen use, obesity, increased \nlevel of estrogen, Lynch syndrome. Endo metrial polyps can \naccurately be diagnosed using transvaginal ultrasonography and \nSaline infusion sonography. All (100%) cases of polyp in \npresent study were treated by polypectomy as they were \nsymptomatic similar to study by Yuk, [16]. \n \nManagement of Adenomyosis  \nAdenomyosis was most commonly found in fourth decade but \nnow increasingly diagnosed in young women with infertility, \ndysmenorrhea and AUB. Although histopathology is the Gold \nStandard in diagnosing Adenomyosis, FIGO now suggests \nMUSA (Morphologica l Uterus Sonographic Assessment) using \ntransvaginal ultrasonography for diagnosis. Treatment goal is \nrelief of pain and bleeding. In present study, 80% cases were \ntreated with progestins. They were found to be effective by \ninducing endometrial atrophy lowering prostaglandin production \nto improve dysmenorrhea and heavy menstrual bleeding \naccording to studies by Muneyyirci -Delale [17]; Osuga, [18]. \n17.8% cases were treated with GnRH agonists. 60.9% cases \nwere hysterectomized. Hysterectomy is the definitive treatment. \n \nManagement of Leiomyoma  \nFibroids are most common pelvic tumours. They can easily be \ndiagnosed on clinical examination and transvaginal and \ntransabdominal ultrasonography. MRI allows more accurate \nassessment of the size, number, and location of l eiomyomas. \nThis helps identify appropriate candidates for myomectomy. \nEither COC pills, Progestins can be used to induce endometrial \natrophy and to decrease prostaglandin production in leiomyomas \naccording to studies by Kriplani [19]; Sayed [20]. GnRH agon ists \nshrink leiomyomas by targeting the growth effects of estrogen \nand progesterone by lowering their levels in 1 to 2 weeks after \ninitial administration. Tranexamic acid decreased myoma \nvolume and improved menstrual symptoms during 3 month \ntherapy accordi ng to studies of Parsanezhad [21]; Sayyah -Melli \n[22]. Myomectomy is a uterus preserving surgery considered for \nwomen who desire fertility preservation or who decline \nhysterectomy. Myomectomy improves heavy menstrual bleeding \nin approximately 70 to 80% pati ents according to studies. \nHysterectomy is definitive treatment. Benefits are balanced \nagainst risks of major surgery. In present study, 45.9% cases \nunderwent hysterectomy, 11.4% underwent myomectomy, \n22.8% were treated with progestins, 14.2% were treated with \nCOC pills and 5.7% were treated with GnRH agonists. \n \nManagement of Malignancy and Hyperplasia  \nIt can be predicted by transvaginal ultrasonography by \nmeasuring endometrial thickness in patients with AUB. \nHowever it is a histological diagnosis by endom etrial biopsy. \nManagement depends on patient’s age, comorbid risks for \nsurgery, desire for fertility and specific histologic features such \nas cytologic atypia. Hysterectomy is the most definitive \ntreatment. Hormonal therapy using progestins lead to regress ion \nrates of 70 -80% for non -atypical endometrial hyperplasia \naccording to studies by Reed [23]. In present study, 71.4% cases \nunderwent hysterectomy, 21.4% cases were treated using \nprogestins and 7.2% cases underwent radical hysterectomy. \n \nManagement of Ovulatory Dysfunction  \nThe underlying cause of anovulation are varied and need to be \nevaluated. If cause is treated symptoms reduce. Symptomatic \nmanagement can be given until cause is corrected using \ntranexamic acid and mefenamic acid, COC pills and progesti ns. \nRegardless of the reason, if ovulation does not occur, no \nprogesterone is produced and a proliferative endometrium \npersists and are at increased risk of endometrial hyperplasia. In \nthose desiring contraception, COC pills and progestins can be \ngiven. In  those not desiring contraception, cyclic monthly \nprogestins will typically regulate menses according to studies by \nMunro [17]. In the present study, 66.6% cases were given \nprogestins and 33.4% were given only  tranexamic and \nmefenamic acid. \n \nManagement of AUB-E cases  \nIt is a diagnosis of exclusion. In the present study, 75% were \ntreated with progestins and 25% were treated with COC pills. In \npresent study, 16.8% cases of hysterectomy were in age group of \n30-40 years, comparable to study by Dr. K. Indira Surya Kumari \net al . [1] (19%), whereas 83.2% cases of hysterectomy were in \nage group of above 40 years, which is more than that in study o f \nDr. K Indira Surya Kumari et al [1]. \n \nConclusion  \nFollowing conclusions were drawn from the present study. The \nmajority of women were in the age group 40 to 44 years. \nIncidence of AUB is more common in multiparous women. The \ncommonest bleeding pattern was heavy menstrual bleeding. \nProliferative type of endometrium was the commonest \nhistopathological pattern. Majority of t hese patients were given \nProgestins as medical line of management, which was found to \nbe superior in controlling abnormal uterine bleeding than others. \nAll polyp patients underwent polypectomy and dilatation and \ncurettage. Majority of patients with adenomy osis were treated \nwith Progestins (LNG -IUS), few underwent hysterectomy. \nNearly half of patients with Leiomyoma underwent \nhysterectomy, few underwent myomectomy. Majority of patients \nwith AUB-M underwent hysterectomy. Majority of patients who \nunderwent hys terectomy were in age group 40 -44 years. Most \ncommon indication for hysterectomy was Leiomyoma, followed \nby Adenomyosis and Malignancy and Hyperplasia. Most patient \nwith AUB-O and AUB-E were treated with Progestins.  \n \nLimitations of my study \n As it is a hospital based study, there is a chance of selection \n\nInternational Journal of Clinical Obstetrics and Gynaecology https://www.gynaecologyjournal.com \n~ 1364 ~ \nbias. \n Regarding medical therapy, especially hormonal therapy \ndifferent regimes were given according to consultant’s \nconsensus. \n \nConflicts of interest \nNot available \n \nFinancial Support \nNot available \n \nReferences \n1. Kumari KIS, Manasa P. Clinical study on hysterectomy for \nAUB as surgical management at tertiary care centre GGH, \nKakinada. International Journal of Clinoical Obstet rics and \nGynaecology. 2019;3(4):13-17  \n2. Mary GS, Tarin AS, Patrice MW. Evaluation and \nmanagement of abnormal uterine bleeding in \npremenopausal women. Am Fam Physician. 2012;85(1):35 -\n43.  \n3. Barbara L. Hoffman, John O. Sch orge et al . Williams \nGynecology. Fourth Edition . United States of America. \nMcGraw-Hill Education; 2020, Chapter 8,9, p. 179-218. \n4. Jonathan S Berek, A.G. Radhika, Rashmi Malik. Berek and \nNovak’s Gynaecology. South Asian edition. Haryana. \nWolters Kluwer Health; 2020. Chapter 10, 11, 12.p197-283  \n5. Singh PB, Purwar R, Mall RP. Clinical spectrum and causes \nof abnormal uterine bleeding in reproductive age according \nto two FIGO systems. The New India n Journal of OBGYN. \n2021;8(1):105-111. \n6. Muzaffar M, Akhtar KAK, Yasmin S, Rehman  MUR, Iqbal \nW, Khan MA. Menstrual Irregularities with excessive blood \nloss: A Clinico-Pathological Correlation. J Pa k Med Assoc. \n2005;55(11):486-489. \n7.  Saraswathi D, Thanka J, Shalinee R, Aarathi R, Jaya V, \nKumar PV. Study of endometrial pathology in abnormal \nuterine bleedi ng. Journal of Obstetrics and Gynecology of \nIndia. 2011;61(4):426-30.  \n8. Lotha L, Borah A. Clinicopat hological evaluation of \nabnormal uterine bleeding in perimenopausal women. Int . J \nReprod Contracept Obstet Gynecol 2016;5:3072-4. \n9. Khan S,  Sadia H, Umber A. Histopathological Pattern of \nEndometrium on Diagnostic D&C in Patients with \nAbnormal uterine bleeding. Annuals 2011;17(2):166-70.  \n10.  Kusum: Assessment of profile of patients with abnormal \nuterine bleeding. Int J Clin Obstet Gynaecol. 2019;8(3):367-\n370. \n11. Sun L, Wang Y, Yang X, Chen S, Liang Y, Luo X, et al. \nPrevalence and risk factors of heavy menstrual ble eding: A \ncross-sectional study. BMC Womens Health. 2021;21:397. \n12. Yilmaz B, Ozel S, Yildirim G, Bozkurt N, Yazici G, Akyol \nM, et al . Prevalence of abnormal uterine bleeding and \nassociated factors in reproductive -age women. J Obstet \nGynaecol. 2020;40(8):1083-9. \n13. Ghani Nadia A, Abdulrazak AA, Abdullah EM. Abnormal \nUterine Bleeding: A Histopathological Study. Diyala \nJournal of Medicine [Internet]. 2019 Nov. 1 [cited 2025 \nDec. 5];4(1):55-60. \n14. Coulter A, Kelland J, Peto V, Rees MC. Treating \nmenorrhagia in primary care. An overview of drug trials and \na survey of prescribing practice. Int J Technol Assess \nHealth Care. 1995;11(3):456-471. \n15. Chanderdeep. et al. Gynecological disease in rural India:A \ncritical appraisal of indications and route of surgery along \nwith histopat hology correlation of 922 women undergoing \nmajor gynaecological surgery/J Midlife Health.  2014 Apr -\nJun;5(2);55-61.  \n16. Yuk J-S, Kim Y -J, Hur J -Y, Shin J H. Uterine polypectomy \nin women with abnormal uterine bleeding: Efficacy and \nclinical outcome. Obstet Gynecol Sci. 2018;61(1):126-132. \n17. Delale MO, Karacan M. Gonadotropin-releasing hormone \nagonist therapy in gynecology: Effects on endometrium and \nmenstrual symptoms. Int . J Fertil Womens Med. \n1996;41(3):278-84. \n18. Osuga Y, Watanabe K, Hagino A, Momoeda M, Terakawa \nN, Okamura K. Efficacy and safety of dienogest in Japanese \nwomen with symptomatic endometriosis: a randomized, \ndouble-blind, placebo -controlled study. Reprod Med Biol. \n2009;8(2):133-141. \n19. Kriplani A, Kulshrestha V. Role of medical management in \nuterine fibro ids. Best Pract Res Clin Obstet Gynaecol. \n2016;34:74-85. \n20. Sayed GH, Zakherah MS, El -Nashar SA, Shaaban MM.A \nrandomized clinical trial of a progestin -releasing \nintrauterine system versus a low -dose combined oral \ncontraceptive for treatment of ovulatory dysfu nctional \nuterine bleeding. Int J Gynaecol Obstet. 2011;112(2):126 -\n30. \n21. Parsanezhad ME, Alborzi S, Rajaeefard A, Zarei A. A \nrandomized, double -blind, placebo -controlled trial of \ntranexamic acid for treatment of uterine leiomyoma -related \nheavy menstrual bleed ing. Fertil Steril. 2010;93(7):2471 -\n2474. \n22. Melli SM, Niloofar GF, Ghojazadeh M, et al. Comparison \nof tranexamic acid and mefenamic acid in reducing fibroid -\nrelated bleeding and pain. Int . J Womens Health. \n2017;9:217-22. \n23. Reed SD, Newton KM, Clinton WL, Epplein M, Garcia RL, \nAllison KH, et al . Progestin therapy for endometrial \nhyperplasia: A systematic review. Obstet Gynecol. \n2009;113(3):655-667. \n \n \nHow to Cite This Article \nHarika G, Anitha A, Shamili G. A study on abnormal uterine bleeding and \nits management in reproductive age women in tertiary care hospital . \nInternational Journal of Clinical Obstetrics and Gynaecology . \n2025;9(6):1359-1364.  \n \n \nCreative Commons (CC) License \nThis is an open -access journal, and articles are distributed under the terms \nof the Creat ive Commons Attribution -Non Commercial-Share Alike 4.0 \nInternational (CC BY -NC-SA 4.0) License, which allows others to remix, \ntweak, and build upon the work non -commercially, as long as appropriate \ncredit is given and the new creations are licensed under the identical terms.","source_license":"CC0","license_restricted":false}