Abnormal Uterine Bleeding

In: Each Woman’s Menopause: An Evidence Based Resource · 2021 · pp. 147–168 · doi:10.1007/978-3-030-85484-3_7 · W4200278725
book-chapter OA: closed CC0
Full text JSON View on OpenAlex View at publisher
AI-generated summary by claude@2026-06+body, 2026-06-09

Abnormal uterine bleeding is defined by ovulatory dysfunction and ovarian aging, potentially exacerbated by conditions like fibroids or coagulation disorders, and managed using the PALM-COEIN system.

One-sentence paraphrase of the abstract; not a substitute for reading it. No clinical advice. How this works

AI-generated deep summary by claude@2026-06, 2026-06-09 · read from full text

This paper/chapter reviews abnormal uterine bleeding (AUB), defined as abnormal infrequent or absent bleeding patterns occurring in the perimenopause stage, and explains how ovulatory dysfunction on top of ovarian aging can alter the menopause transition trajectory. It describes how independent etiologies—including polycystic ovarian syndrome, functional hypothalamic amenorrhea, uterine fibroids, coagulation disorders, and adenomyosis—may combine with late reproductive and perimenopausal states to worsen bleeding patterns, and it notes that managing acute heavy menstrual bleeding is the first priority. It organizes epidemiology, etiology, and management of AUB using the PALM-COEIN system, while explicitly framing the content as a classification/management overview rather than new empirical results. Relevance to endometriosis: adenomyosis (a related cause of AUB in the context of uterine bleeding) is explicitly mentioned as worsening during menopause transition hormonal alterations, though the paper’s main focus is an overarching clinical/epidemiologic framework for AUB.

Read from the paper's body, not the abstract. Not a substitute for reading the paper. No clinical advice. How this works

Full text 25,369 characters · extracted from oa-doi-fallback · 2 sections · click to expand

Abstract

By definition, abnormal uterine bleeding (AUB) occurs in the perimenopause stage of life. Abnormal infrequent or absent bleeding must be distinguished from expected bleeding patterns. When ovulatory dysfunction is superimposed upon ovarian aging, the trajectory of the menopause transition is altered. Independent etiologies of abnormal bleeding such as polycystic ovarian syndrome and functional hypothalamic amenorrhea may combine with the late reproductive stage (LRS) and perimenopause stage to further alter bleeding patterns. Bleeding in women with uterine fibroids, coagulation disorders, and adenomyosis may become intolerable and harmful when exacerbated by the menopause transition hormonal alterations. Management of acute heavy menstrual bleeding is always the first priority. The PALM-COEIN system summarizes the epidemiology, etiology, and management of AUB. Access this chapter Tax calculation will be finalised at checkout Purchases are for personal use only Similar content being viewed by others

References

Fraser IS, Critchley HO, Munro MG, Broder M. A process designed to lead to international agreement on terminologies and definitions used to describe abnormalities of menstrual bleeding. Fertil Steril. 2007;87:466–76. Munro MG, Critchley HOD, Fraser IS, FIGO Menstrual Disorders Committee. The two FIGO systems for normal and abnormal uterine bleeding symptoms and classification of causes of abnormal uterine bleeding in the reproductive years: 2018 revisions. Int J Gynaecol Obstet. 2018;143(3):393–408. https://doi.org/10.1002/ijgo.12666. Erratum in: Int J Gynaecol Obstet. 2019;144(2):237. PMID: 30198563. Sharp HT, Johnson JV, Lemieux LA, Currigan SM. Executive summary of the reVITALize initiative: standardizing gynecologic data definitions. Obstet Gynecol. 2017;129(4):603–7. https://doi.org/10.1097/AOG.0000000000001939. Erratum in: Obstet Gynecol. 2019;133(2):382. PMID: 28277367. American College of Obstetricians and Gynecologists. ACOG committee opinion no. 557: Management of acute abnormal uterine bleeding in nonpregnant reproductive-aged women. Obstet Gynecol. 2013;121(4):891–6. https://doi.org/10.1097/01.AOG.0000428646.67925.9a. PMID: 23635706. Munro M, Critchley H, Fraser I. The FIGO systems for nomenclature and classification of causes of abnormal uterine bleeding in the reproductive years: who needs them? Am J Obstet Gynecol. 2012;207(4):259–65. National Institute for Health and Clinical Excellence. Heavy menstrual bleeding assessment and management. NICE Guideline 88. London: National Institute for Health and Clinical Excellence; 2018. Updated March 2020. https://www.nice.org.uk/guidance/ng88. Accessed 21 Nov 2020. Liu Z, Doan QV, Blumenthal P, Dubois RW. A systematic review evaluating health-related quality of life, work impairment, and health-care costs and utilization in abnormal uterine bleeding. Value Health. 2007;10:183–94. Bang RA, Bang AT, Baitule M, Choudhary Y, Sarmukaddam S, Tale O. High prevalence of gynaecological diseases in rural Indian women. Lancet. 1989;1:85–8. Harlow SD, Campbell OM. Epidemiology of menstrual disorders in developing countries: a systematic review. BJOG. 2004;111:6–16. Ligon AH, Morton CC. Leiomyomata: heritability and cytogenetic studies. Hum Reprod Update. 2001;7(1):8–14. https://doi.org/10.1093/humupd/7.1.8. PMID: 11212080. Gallagher CS, Mäkinen N, Harris HR, Rahmioglu N, Uimari O, Cook JP, Shigesi N, Ferreira T, Velez-Edwards DR, Edwards TL, Mortlock S, Ruhioglu Z, Day F, Becker CM, Karhunen V, Martikainen H, Järvelin MR, Cantor RM, Ridker PM, Terry KL, Buring JE, Gordon SD, Medland SE, Montgomery GW, Nyholt DR, Hinds DA, Tung JY, 23andMe Research Team, Perry JRB, Lind PA, Painter JN, Martin NG, Morris AP, Chasman DI, Missmer SA, Zondervan KT, Morton CC. Genome-wide association and epidemiological analyses reveal common genetic origins between uterine leiomyomata and endometriosis. Nat Commun. 2019;10(1):4857. https://doi.org/10.1038/s41467-019-12536-4. PMID: 31649266; PMCID: PMC6813337. Baird DD, et al. High cumulative incidence of uterine leiomyoma in black and white women: ultrasound evidence. Am J Obstet Gynecol. 2003;188(1):100–7. Wise LA, Ruiz-Narvaez EA, Palmer JR, Cozier YC, Tandon A, Patterson N, Radin RG, Rosenberg L, Reich D. African ancestry and genetic risk for uterine leiomyomata. Am J Epidemiol. 2012;176(12):1159–68. https://doi.org/10.1093/aje/kws276. PMID: 23161897; PMCID: PMC3571235. Kalot MA, Al-Khatib M, Connell NT, Flood V, Brignardello-Petersen R, James P, Mustafa RA, VWD Working Group. An international survey to inform priorities for new guidelines on von Willebrand disease. Haemophilia. 2020;26(1):106–16. https://doi.org/10.1111/hae.13881. PMID: 31769905; PMCID: PMC7041556. Srivastava A, Rodeghiero F. Epidemiology of von Willebrand disease in developing countries. Semin Thromb Hemost. 2005;31(5):569–76. https://doi.org/10.1055/s-2005-922229. PMID: 16276466. Zheng C, Zhang B. Combined deficiency of coagulation factors V and VIII: an update. Semin Thromb Hemost. 2013;39(6):613–20. https://doi.org/10.1055/s-0033-1349223. PMID: 23852824; PMCID: PMC4446966. Taylor HS, Pal L, Seli E. Speroff’s clinical gynecologic endocrinology and infertility. 9th ed. Philadelphia, PA: Wolters Kluwer; 2020. p. 524–5. James AH, Kouides PA, Abdul-Kadir R, Dietrich JE, Edlund M, Federici AB, Halimeh S, Kamphuisen PW, Lee CA, Martínez-Perez O, McLintock C, Peyvandi F, Philipp C, Wilkinson J, Winikoff R. Evaluation and management of acute menorrhagia in women with and without underlying bleeding disorders: consensus from an international expert panel. Eur J Obstet Gynecol Reprod Biol. 2011;158(2):124–34. https://doi.org/10.1016/j.ejogrb.2011.04.025. PMID: 21632169. Zreik TG, Odunsi K, Cass I, Olive DL, Sarrel P. A case of fatal pulmonary thromboembolism associated with the use of intravenous estrogen therapy. Fertil Steril. 1999;71(2):373–5. https://doi.org/10.1016/s0015-0282(98)00446-4. PMID: 9988414. Department of Reproductive Health, World Health Organization. Medical eligibility criteria for contraceptive use. 5th ed. Geneva: World Health Organization; 2015. Munro MG, Mainor N, Basu R, Brisinger M, Barreda L. Oral medroxyprogesterone acetate and combination oral contraceptives for acute uterine bleeding: a randomized controlled trial. Obstet Gynecol. 2006;108(4):924–9. https://doi.org/10.1097/01.AOG.0000238343.62063.22. PMID: 17012455. CRASH-2 Trial Collaborators, Shakur H, Roberts I, Bautista R, Caballero J, Coats T, Dewan Y, El-Sayed H, Gogichaishvili T, Gupta S, Herrera J, Hunt B, Iribhogbe P, Izurieta M, Khamis H, Komolafe E, Marrero MA, Mejía-Mantilla J, Miranda J, Morales C, Olaomi O, Olldashi F, Perel P, Peto R, Ramana PV, Ravi RR, Yutthakasemsunt S. Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant hemorrhage (CRASH-2): a randomized, placebo-controlled trial. Lancet. 2010;376(9734):23–32. https://doi.org/10.1016/S0140-6736(10)60835-5. PMID: 20554319. WOMAN Trial Collaborators. Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial. Lancet. 2017;389(10084):2105–16. https://doi.org/10.1016/S0140-6736(17)30638-4. Erratum in: Lancet. 2017;389(10084):2104. PMID: 28456509; PMCID: PMC5446563. Berntorp E, Follrud C, Lethagen S. No increased risk of venous thrombosis in women taking tranexamic acid. Thromb Haemost. 2001;86(2):714–5. PMID: 11522029. Sundström A, Seaman H, Kieler H, Alfredsson L. The risk of venous thromboembolism associated with the use of tranexamic acid and other drugs used to treat menorrhagia: a case-control study using the General Practice Research Database. BJOG. 2009;116(1):91–7. https://doi.org/10.1111/j.1471-0528.2008.01926.x. PMID: 19016686. Bryant-Smith AC, Lethaby A, Farquhar C, Hickey M. Antifibrinolytics for heavy menstrual bleeding. Cochrane Database Syst Rev. 2018;4(4):CD000249. https://doi.org/10.1002/14651858.CD000249.pub2. PMID: 29656433; PMCID: PMC6494516. Van Voorhis BJ, Santoro N, Harlow S, Crawford SL, Randolph J. The relationship of bleeding patterns to daily reproductive hormones in women approaching menopause. Obstet Gynecol. 2008;112(1):101–8. https://doi.org/10.1097/AOG.0b013e31817d452b. PMID: 18591314; PMCID: PMC2666050. Hale G, Manconi F, Luscombe G, Fraser IS. Quantitative measurements of menstrual blood loss in ovulatory and anovulatory cycles in middle- and late-reproductive age and the menopause transition. Obstet Gynecol. 2010;115(2):249–56. Louwers YV, Laven JSE. Characteristics of polycystic ovary syndrome throughout life. Ther Adv Reprod Health. 2020;14:2633494120911038. https://doi.org/10.1177/2633494120911038. Wolf WM, Wattick RA, Kinkade ON, Olfert MD. Geographical prevalence of polycystic ovary syndrome as determined by region and race/ethnicity. Int J Environ Res Public Health. 2018;15(11):2589. https://doi.org/10.3390/ijerph15112589. PMID: 30463276; PMCID: PMC6266413. Goodman NF, Cobin RH, Futterweit W, Glueck JS, Legro RS, Carmina E, American Association of Clinical Endocrinologists (AACE); American College of Endocrinology (ACE); Androgen Excess and PCOS Society. American association of clinical endocrinologists, American College of Endocrinology, and Androgen Excess and PCOS society disease state clinical review: guide to the best practices in the evaluation and treatment of polycystic ovary syndrome - part 2. Endocr Pract. 2015;21(12):1415–26. https://doi.org/10.4158/EP15748.DSCPT2. PMID: 26642102. Azziz R. Introduction: determinants of polycystic ovary syndrome. Fertil Steril. 2016;106(1):4–5. https://doi.org/10.1016/j.fertnstert.2016.05.009. PMID: 27238627. Brown ZA, Louwers YV, Fong SL, Valkenburg O, Birnie E, de Jong FH, Fauser BC, Laven JS. The phenotype of polycystic ovary syndrome ameliorates with aging. Fertil Steril. 2011;96(5):1259–65. https://doi.org/10.1016/j.fertnstert.2011.09.002. PMID: 21963227. Carmina E, Campagna AM, Lobo RA. A 20-year follow-up of young women with polycystic ovary syndrome. Obstet Gynecol. 2012;119(2 Pt 1):263–9. https://doi.org/10.1097/AOG.0b013e31823f7135. PMID: 22270277. de Medeiros SF, Yamamoto MMW, Souto de Medeiros MA, Barbosa BB, Soares JM, Baracat EC. Changes in clinical and biochemical characteristics of polycystic ovary syndrome with advancing age. Endocr Connect. 2020;9(2):74–89. https://doi.org/10.1530/EC-19-0496. Dunselman GA, Vermeulen N, Becker C, Calhaz-Jorge C, D’Hooghe T, De Bie B, Heikinheimo O, Horne AW, Kiesel L, Nap A, Prentice A, Saridogan E, Soriano D, Nelen W, European Society of Human R & Embryology. ESHRE guideline: management of women with endometriosis. Hum Reprod. 2014;29:400–12. Wise LA, Laughlin-Tommaso SK. Epidemiology of uterine fibroids: from menarche to menopause. Clin Obstet Gynecol. 2016;59(1):2–24. https://doi.org/10.1097/GRF.0000000000000164. Okogbo FO, Ezechi OC, Loto OM, Ezeobi PM. Uterine Leiomyomata in South Western Nigeria: a clinical study of presentations and management outcome. Afr Health Sci. 2011;11(2):271–8. PMID: 21857861; PMCID: PMC3158515. Ezeama C, Ikechebelu J, Obiechina NJ, Ezeama N. Clinical presentation of uterine fibroids in Nnewi, Nigeria: a 5-year review. Ann Med Health Sci Res. 2012;2(2):114–8. https://doi.org/10.4103/2141-9248.105656. PMID: 23440007; PMCID: PMC3573503. Whiteman MK, Kuklina E, Jamieson DJ, Hillis SD, Marchbanks PA. Inpatient hospitalization for gynecologic disorders in the United States. Am J Obstet Gynecol. 2010;202(6):541.e1–6. https://doi.org/10.1016/j.ajog.2009.12.013. PMID: 20132921. Aksoy AN, Sarikas GT, Gozgec EG. The effect of copper intrauterine device use duration on uterine and ovarian blood flow parameters: a prospective cross-sectional study. J Clin Ultrasound. 2021;49(2):124–8. https://doi.org/10.1002/jcu.22953. PMID: 33269484. Hubacher D, Chen PL, Park S. Side effects from the copper IUD: do they decrease over time? Contraception. 2009;79(5):356–62. https://doi.org/10.1016/j.contraception.2008.11.012. PMID: 19341847; PMCID: PMC2702765. Bryk AH, Piróg M, Plens K, Undas A. Heavy menstrual bleeding in women treated with rivaroxaban and vitamin K antagonists and the risk of recurrent venous thromboembolism. Vascul Pharmacol. 2016;87:242–7. https://doi.org/10.1016/j.vph.2016.11.003. Epub 2016 Nov 16. PMID: 27865826. Andrade C, Sandarsh S, Chethan KB, Nagesh KS. Serotonin reuptake inhibitor antidepressants and abnormal bleeding: a review for clinicians and a reconsideration of mechanisms. J Clin Psychiatry. 2010;71(12):1565–75. https://doi.org/10.4088/JCP.09r05786blu. PMID: 21190637. Philipp CS, Faiz A, Dowling N, Dilley A, Michaels LA, Ayers C, Miller CH, Bachmann G, Evatt B, Saidi P. Age and the prevalence of bleeding disorders in women with menorrhagia. Obstet Gynecol. 2005;105(1):61–6. https://doi.org/10.1097/01.AOG.0000148889.15061.fb. PMID: 15625143. Kouides PA, Conard J, Peyvandi F, Lukes A, Kadir R. Hemostasis and menstruation: appropriate investigation for underlying disorders of hemostasis in women with excessive menstrual bleeding. Fertil Steril. 2005;84(5):1345–51. https://doi.org/10.1016/j.fertnstert.2005.05.035. PMID: 16275228. Critchley HOD, Babayev E, Bulun SE, Clark S, Garcia-Grau I, Gregersen PK, Kilcoyne A, Kim JJ, Lavender M, Marsh EE, Matteson KA, Maybin JA, Metz CN, Moreno I, Silk K, Sommer M, Simon C, Tariyal R, Taylor HS, Wagner GP, Griffith LG. Menstruation: science and society. Am J Obstet Gynecol. 2020;223(5):624–64. https://doi.org/10.1016/j.ajog.2020.06.004. PMID: 32707266; PMCID: PMC7661839. Whitaker L, Critchley HO. Abnormal uterine bleeding. Best Pract Res Clin Obstet Gynaecol. 2016;34:54–65. https://doi.org/10.1016/j.bpobgyn.2015.11.012. Burger HG. Unpredictable endocrinology of the menopause transition: clinical, diagnostic and management implications. Menopause Int. 2011;17(4):153–4. https://doi.org/10.1258/mi.2011.011026. PMID: 22120939. ACOG Committee. Screening and management of bleeding disorders in adolescents with heavy menstrual bleeding: ACOG committee opinion 785. Obstet Gynecol. 2019;134(3):e71–83. Leminen H, Hurskainen R. Tranexamic acid for the treatment of heavy menstrual bleeding: efficacy and safety. Int J Women’s Health. 2012;4:413–21. https://doi.org/10.2147/IJWH.S13840. Goldstein SR, Lumsden MA. Abnormal uterine bleeding in perimenopause. Climacteric. 2017;20:414. https://doi.org/10.1080/13697137.2017.1358921. Lethaby A, Wise MR, Weterings MA, Bofill Rodriguez M, Brown J. Combined hormonal contraceptives for heavy menstrual bleeding. Cochrane Database Syst Rev. 2019;2(2):CD000154. https://doi.org/10.1002/14651858.CD000154.pub3. PMID: 30742315; PMCID: PMC6369862. Bofill Rodriguez M, Lethaby A, Low C, Cameron IT. Cyclical progestogens for heavy menstrual bleeding. Cochrane Database Syst Rev. 2019;8(8):CD001016. https://doi.org/10.1002/14651858. CD001016.pub3. PMID: 31425626; PMCID: PMC6699663. Lethaby A, Augood C, Duckitt K, Farquhar C. Nonsteroidal anti-inflammatory drugs for heavy menstrual bleeding. Cochrane Database Syst Rev. 2007;(4):CD000400. https://doi.org/10.1002/14651858.CD000400.pub2. Update in: Cochrane Database Syst Rev. 2013;1:CD000400. PMID: 17943741. Pinkerton JAV. Pharmacological therapy for abnormal uterine bleeding. Menopause. 2011;18(4):459–67. https://doi.org/10.1097/gme.0b013e318212499c. Magalhães J, Aldrighi JM, de Lima GR. Uterine volume and menstrual patterns in users of the levonorgestrel-releasing intrauterine system with idiopathic menorrhagia or menorrhagia due to leiomyomas. Contraception. 2007;75(3):193–8. https://doi.org/10.1016/j.contraception.2006.11.004. PMID: 17303488. Farris M, Bastianelli C, Rosato E, Brosens I, Benagiano G. Uterine fibroids: an update on current and emerging medical treatment options. Ther Clin Risk Manag. 2019;15:157–78. Al-Hendy A, Bradley L, Owens CD, Wang H, Barnhart KT, Feinberg E, Schlaff WD, Puscheck EE, Wang A, Gillispie V, Hurtado S, Muneyyirci-Delale O, Archer DF, Carr BR, Simon JA, Stewart EA. Predictors of response for elagolix with add-back therapy in women with heavy menstrual bleeding associated with uterine fibroids. Am J Obstet Gynecol. 2021;224:72.e1. https://doi.org/10.1016/j.ajog.2020.07.032. S0002-9378(20)30751-1. PMID: 32702363. Taylor HS, Giudice LC, Lessey BA, Abrao MS, Kotarski J, Archer DF, Diamond MP, Surrey E, Johnson NP, Watts NB, Gallagher JC, Simon JA, Carr BR, Dmowski WP, Leyland N, Rowan JP, Duan WR, Ng J, Schwefel B, Thomas JW, Jain RI, Chwalisz K. Treatment of Endometriosis-Associated Pain with Elagolix, an Oral GnRH Antagonist. N Engl J Med. 2017;377(1):28–40. https://doi.org/10.1056/NEJMoa1700089. Epub 2017 May 19. PMID: 28525302. Simon JA, Al-Hendy A, Archer DF, et al. Elagolix treatment for up to 12 months in women with heavy menstrual bleeding and uterine leiomyomas. Obstet Gynecol. 2020;135(6):1313–26. https://doi.org/10.1097/AOG.0000000000003869. Donnez J, Donnez O, Matule D, Ahrendt HJ, Hudecek R, Zatik J, Kasilovskiene Z, Dumitrascu MC, Fernandez H, Barlow DH, Bouchard P, Fauser BC, Bestel E, Loumaye E. Long-term medical management of uterine fibroids with ulipristal acetate. Fertil Steril. 2016;105(1):165–173.e4. https://doi.org/10.1016/j.fertnstert.2015.09.032. PMID: 26477496. Fauser BC, Donnez J, Bouchard P, Barlow DH, Vázquez F, Arriagada P, Skouby SO, Palacios S, Tomaszewski J, Lemieszczuk B, William AR. Safety after extended repeated use of ulipristal acetate for uterine fibroids. PLoS One. 2017;12(3):e0173523. https://doi.org/10.1371/journal.pone.0173523. PMID: 28267814; PMCID: PMC5340384. Donnez J, Arriagada P, Marciniak M, Larrey D. Liver safety parameters of ulipristal acetate for the treatment of uterine fibroids: a comprehensive review of the clinical development program. Expert Opin Drug Saf. 2018;17(12):1225–32. https://doi.org/10.1080/14740338.2018.1550070. PMID: 30460871. European Medicines Agency. Ulipristal acetate gedeon richter, INN - ulipristal acetate. London: European Medicines Agency; 2018. https://europa.eu/. Accessed 28 Nov 2020. Indraccolo U, Conzadori S, Greco P. Which is the destiny of ulipristal acetate for uterine fibroids? A commentary on the Italian medicines agency (AIFA) pronouncements. Recenti Prog Med. 2019;110(2):98–9. https://doi.org/10.1701/3112.31006. English. PMID: 30843536. Neuwirth RS, Loffer FD, Trenhaile T, Levin B. The incidence of endometrial cancer after endometrial ablation in a low-risk population. J Am Assoc Gynecol Laparosc. 2004;11(4):492–4. https://doi.org/10.1016/s1074-3804(05)60081-3. PMID: 15701191. Bergeron C, Laberge PY, Boutin A, Thériault MA, Valcourt F, Lemyre M, Maheux-Lacroix S. Endometrial ablation or resection versus levonorgestrel intra-uterine system for the treatment of women with heavy menstrual bleeding and a normal uterine cavity: a systematic review with meta-analysis. Hum Reprod Update. 2020;26(2):302–11. https://doi.org/10.1093/humupd/dmz051. PMID: 31990359. Wortman M. Late-onset endometrial ablation failure. Case Rep Womens Health. 2017;15:11–28. https://doi.org/10.1016/j.crwh.2017.07.001. PMID: 29593995; PMCID: PMC5842972. Longinotti MK, Jacobson GF, Hung YY, Learman LA. Probability of hysterectomy after endometrial ablation. Obstet Gynecol. 2008;112:1214–20. Hutchins FL Jr, Worthington-Kirsch R, Berkowitz RP. Selective uterine artery embolization as primary treatment for symptomatic leiomyomata uteri. J Am Assoc Gynecol Laparosc. 1999;6(3):279–84. Spies JB. Current role of uterine artery embolization in the management of uterine fibroids. Clin Obstet Gynecol. 2016;59(1):93–102. https://doi.org/10.1097/GRF.0000000000000162. PMID: 26630074. Gupta JK, Sinha A, Lumsden MA, Hickey M. Uterine artery embolization for symptomatic uterine fibroids. Cochrane Database Syst Rev. 2014;12:CD005073. https://doi.org/10.1002/14651858.CD005073.pub4. PMID: 25541260. van der Kooij SM, Ankum WM, Hehenkamp WJ. Review of nonsurgical/minimally invasive treatments for uterine fibroids. Curr Opin Obstet Gynecol. 2012;24(6):368–75. https://doi.org/10.1097/GCO.0b013e328359f10a. PMID: 23014141. Harlow SD, Gass M, Hall JE, Lobo R, Maki P, Rebar RW, Sherman S, Sluss PM, de Villiers TJ, STRAW + 10 Collaborative Group. Executive summary of the Stages of Reproductive Aging Workshop + 10: addressing the unfinished agenda of staging reproductive aging. J Clin Endocrinol Metab. 2012;97(4):1159–68. https://doi.org/10.1210/jc.2011-3362. PMID: 22344196; PMCID: PMC3319184. Allshouse A, Pavlovic J, Santoro N. Menstrual cycle hormone changes associated with reproductive aging and how they may relate to symptoms. Obstet Gynecol Clin N Am. 2018;45(4):613–28. https://doi.org/10.1016/j.ogc.2018.07.004. PMID: 30401546; PMCID: PMC6226272. Santoro N, Crawford SL, El Khoudary SR, Allshouse AA, Burnett-Bowie SA, Finkelstein J, Derby C, Matthews K, Kravitz HM, Harlow SD, Greendale GA, Gold EB, Kazlauskaite R, McConnell D, Neal-Perry G, Pavlovic J, Randolph J, Weiss G, Chen HY, Lasley B. Menstrual Cycle Hormone Changes in Women Traversing Menopause: Study of Women’s Health Across the Nation. J Clin Endocrinol Metab. 2017;102(7):2218–29. https://doi.org/10.1210/jc.2016-4017. PMID: 28368525; PMCID: PMC5505186. Santoro N. Menopause. In: Crandall C, Bachman G, Faubion S, Klein W, Liu J, Manson JE, Mortimer J, Pinkerton JV, Santoro N, Shifre JL, Thurston RC, editors. Menopause practice; a clinician’s guide. 6th ed. Pepper Pike, OH: North American Menopause Society; 2019. p. 1–21. Vilar L, Vilar CF, Lyra R, Freitas MDC. Pitfalls in the diagnostic evaluation of hyperprolactinemia. Neuroendocrinology. 2019;109(1):7–19. https://doi.org/10.1159/000499694. PMID: 30889571. Steunkel CA, et al. Fertil Steril. 2012;98(2):0015–282. https://doi.org/10.1016/j.fertnstert.2012.05.051. Baber RJ, Panay N, Fenton A, IMS Writing Group. 2016 IMS Recommendations on women’s midlife health and menopause hormone therapy. Climacteric. 2016;19(2):109–50. https://doi.org/10.3109/13697137.2015.1129166. PMID: 26872610. Furness S, Roberts H, Marjoribanks J, Lethaby A. Hormone therapy in postmenopausal women and risk of endometrial hyperplasia. Cochrane Database Syst Rev. 2012;2012(8):CD000402. Bjarnason K, Cerin A, Lindgren R, Weber T. Adverse endometrial effects during long cycle hormone replacement therapy. Scandinavian Long Cycle Study Group. Maturitas. 1999;32:161–70. Somboonporn W, Panna S, Temtanakitpaisan T, Kaewrudee S, Soontrapa S. Effects of the levonorgestrel-releasing intrauterine system plus estrogen therapy in perimenopausal and postmenopausal women: systematic review and meta-analysis. Menopause. 2011;18(10):1060–6. https://doi.org/10.1097/gme.0b013e31821606c5. Raglan O, Kalliala I, Markozannes G, Cividini S, Gunter MJ, Nautiyal J, Gabra H, Paraskevaidis E, Martin-Hirsch P, Tsilidis KK, Kyrgiou M. Risk factors for endometrial cancer: an umbrella review of the literature. Int J Cancer. 2019;145(7):1719–30. https://doi.org/10.1002/ijc.31961. PMID: 30387875. Chandra V, Kim JJ, Benbrook DM, Dwivedi A, Rai R. Therapeutic options for management of endometrial hyperplasia. J Gynecol Oncol. 2016;27(1):e8. https://doi.org/10.3802/jgo.2016.27.e8. PMID: 26463434; PMCID: PMC4695458. Santoro N, Crawford SL, El Khoudary SR, Allshouse AA, Burnett-Bowie SA, Finkelstein J, Derby C, Matthews K, Kravitz HM, Harlow SD, Greendale GA, Gold EB, Kazlauskaite R, McConnell D, Neal-Perry G, Pavlovic J, Randolph J, Weiss G, Chen HY, Lasley B. Menstrual cycle hormone changes in women traversing menopause: study of women’s health across the nation. J Clin Endocrinol Metab. 2017;102(7):2218–29. https://doi.org/10.1210/jc.2016-4017. PMID: 28368525; PMCID: PMC5505186. Munro MG, Southern California Permanente Medical Group’s Abnormal Uterine Bleeding Working Group. Investigation of women with postmenopausal uterine bleeding: clinical practice recommendations. Perm J. 2014;18(1):55–70. https://doi.org/10.7812/TPP/13-072. PMID: 24377427; PMCID: PMC3951032. National Academies of Sciences, Engineering, and Medicine. The clinical utility of compounded bioidentical hormone therapy: a review of safety, effectiveness, and use. Washington, DC: The National Academies Press; 2020. https://doi.org/10.17226/25791. Gupta JK, Chien PF, Voit D, Clark TJ, Khan KS. Ultrasonographic endometrial thickness for diagnosing endometrial pathology in women with postmenopausal bleeding: a meta-analysis. Acta Obstet Gynecol Scand. 2002;81:799–816. American College of Obstetricians and Gynecologists. Committee Opinion No. 734: the role of transvaginal ultrasonography in evaluating the endometrium of women with postmenopausal bleeding. Obstet Gynecol. 2018;131(5):e124–9. Author information Authors and Affiliations Corresponding author Editor information Editors and Affiliations Rights and permissions Copyright information © 2022 The Author(s), under exclusive license to Springer Nature Switzerland AG About this chapter Cite this chapter Geraghty, P. (2022). Abnormal Uterine Bleeding. In: Geraghty, P. (eds) Each Woman’s Menopause: An Evidence Based Resource. Springer, Cham. https://doi.org/10.1007/978-3-030-85484-3_7 Download citation DOI: https://doi.org/10.1007/978-3-030-85484-3_7 Published: Publisher Name: Springer, Cham Print ISBN: 978-3-030-85483-6 Online ISBN: 978-3-030-85484-3 eBook Packages: MedicineMedicine (R0)

Text is read by the "Ask this paper" AI Q&A widget below. Extraction quality varies by source — PMC NXML preserves structure cleanly, OA-HTML may include some navigation residue, and OA-PDF can have broken hyphenation. The publisher copy (via DOI) is the canonical version.

My notes (saved in your browser only)

Ask this paper AI returns verbatim quotes from the full text · source: oa-doi-fallback

Answers must be backed by verbatim quotes from this paper's full text. Hallucinated quotes are dropped automatically; if no verbatim passage answers the question, we say so. How this works

Citation neighborhood

Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

References (86)

Source provenance

openalex
last seen: 2026-06-04T00:00:01.174412+00:00
unpaywall
last seen: 2026-06-02T02:00:03.124865+00:00
License: CC0 · commercial use OK