Investigation and management of abnormal uterine bleeding in reproductive-aged women: a descriptive review of national and international recommendations

Ιoannis Tsakiridis, Sonia Giouleka, Georgia Koutsouki, Nikolaos Kostakis, Ioannis Kalogiannidis, Anargyros Kourtis, Apostolos Athanasiadis, Dimitrios G. Goulis, Themistoklis Dagklis
In: The European Journal of Contraception & Reproductive Health Care · 2022 · vol. 27(6) , pp. 504–517 · doi:10.1080/13625187.2022.2112169 · PMID:36053280 · W4294311851
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This review compares national and international recommendations for abnormal uterine bleeding, finding consensus on history, physical exam, transvaginal ultrasound, and hormonal treatments while noting discrepancies in laboratory testing and biopsy guidelines.

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Abstract

PURPOSE: To review and compare the most recently published recommendations on the investigation and management of abnormal uterine bleeding (AUB). MATERIALS AND METHODS: A descriptive review of recommendations from the American College of Obstetricians and Gynaecologists (ACOG), the National Institute for Health and Care Excellence (NICE), the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG), the Society of Obstetricians and Gynaecologists of Canada (SOGC) and the International Federation of Gynaecology and Obstetrics (FIGO) on AUB in reproductive-aged women was carried out. RESULTS: There is a consensus that detailed personal and family history along with physical examination are essential in the investigation of menstrual, intermenstrual or postcoital AUB. All the medical societies recommend transvaginal ultrasound as the first-line imaging modality to determine the AUB cause. Moreover, they agree (except for RANZCOG) that, in women with AUB, endometrial biopsy should only be performed if additional risk factors for endometrial cancer are present. Laboratory tests may be helpful in the AUB investigation; however, there are several discrepancies among the recommendations. Regarding AUB management, NICE, ACOG and SOGC agree that the administration of hormonal or non-hormonal medications should be the first-line treatment modality in bleeding disorders and absent or minor structural pelvic pathology. Surgical management should be preferred in cases of identified polyps, large fibroids or unsuccessful pharmacological treatment. CONCLUSIONS: Since AUB affects a significant proportion of reproductive-aged women, the main objective is to improve the quality of life of these patients without missing cases of malignancy.

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