Abnormal uterine bleeding

Ying Cheong, Cameron IT, Iain T. Cameron, Critchley HOD, Hilary Critchley, Hilary O D Critchley
British medical bulletin · 2017 · vol. 123(1) , pp. 103–114 · doi:10.1093/bmb/ldx027 · PMID:28910998 · W4236382350
review OA: bronze CC0 ⤵ 21 in-corpus citations
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This review outlines the universal diagnostic approach to abnormal uterine bleeding using PALM-COEIN, discussing established medical and surgical treatments and areas needing further research in diagnosis and management.

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Abstract

Introduction: It is not uncommon for a woman to suffer from abnormal uterine bleeding (AUB) or heavy menstrual bleeding (HMB) at some point during her lifetime. Once pathology is excluded, in practice, management needs to be individualised, taking into account the improvement of the woman's symptoms and quality of life. Sources of data: Peer-reviewed journals, governmental and professional society publications. Areas of agreement: There is now agreement on a structured, universal approach to the diagnosis of AUB, with the aide memoirs PALM (polyps, adenomyosis, leiomyoma, malignancy) and COEIN (coagulopathies, ovulatory dysfunction, endometrial, iatrogenic, not otherwise classified). Once malignancy and significant pelvic pathology have been ruled out, medical treatment is an effective first-line therapeutic option, with surgery, including endometrial ablation and hysterectomy, offered when medical management has failed to resolve symptoms and fertility is no longer desired. Areas of controversy: There remains controversy around the management of the types and subtypes of adenomyosis and leiomyoma, and understanding their impact on clinical reproductive outcomes. Areas currently under development: Standardised assessment tools for measuring outcomes of AUB are being developed. Areas timely for developing research: Novel diagnostic and monitoring tools should be developed to help stratify treatment for women with AUB, particularly relating to 'unclassified' and 'endometrial' causes.

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Condition tags

adenomyosis

MeSH descriptors

Uterine Hemorrhage Adenomyosis Adenomyosis Adenomyosis Female Humans Hysterectomy Leiomyoma Leiomyoma Leiomyoma Polyps Polyps Polyps Quality of Life Uterine Hemorrhage Uterine Hemorrhage

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Cited by (21)

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License: CC0 · commercial use OK