Treatment options for dysfunctional uterine bleeding. Abnormal uterine bleeding is a diagnosis of exclusion in which there is abnormal bleeding i. Abnormal uterine bleeding between menarche and menopause figure 2. Abnormal uterine bleeding is a common condition, with a prevalence of 10% to 30% among women of reproductive age. Currently, there are no guidelines for comprehensive evaluation and management of dub, and most existing guidelines focus on narrow and specific etiology and age groups. The term dysfunctional uterine bleeding is sometimes used to encompass.
Abnormal uterine bleeding aub is a condition that affects approximately 30% of women during their reproductive years. Dysfunctional uterine bleeding dub, the most common cause of abnormal uterine bleeding, occurs most often in women 45 50% of cases and in adolescents 20% of cases. Clinical practice clinical update dysfunctional uterine. 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. Evaluation and management of adolescents with abnormal uterine bleeding.
Because of this complexity, concise guidelines have been dif. Prepared by the vanderbilt evidencebased practice center under contract no. Nursing care plan dysfunctional uterine bleeding vylyz0yzze4m. In ovulatory dysfunctional uterine bleeding, generally circulating ovarian hormone levels. Abnormal uterine bleeding symptoms, diagnosis and treatment. Outline a strategy for diagnosis and management of abnormal vaginal bleeding. The term dysfunctional uterine bleeding is a diagnosis of exclusion, reached when. Clinical policy effective11012011 19962012, oxford health plans, llc 3 manual endometrial ablation. In cases of acute and severe bleeding, women may need urgent treatment with. Abnormal uterine bleeding has various definitions and. Management of women with bleeding irregulatories while sing contraception, u. Guidelines for the management of heavy menstrual bleeding. Abnormal uterine bleeding is a broad term that indicates a change in frequency of menses, duration of flow or. Dysfunctional uterine bleeding is the diagnosis in the majority of cases of menorrhagia.
We are currently working through back issues of afp for the afp website. Once pathology is excluded, in practice, management needs to be individualised, taking into account the improvement of the. The type of an ovulator y bleeding is physiological and commonly seen soon after menarche and at premenopausal period. May 16, 2018 the bleeding was never heavy, but it still created a big problem for the couple because it made sexual intercourse between them improbable. Apr 18, 2016 dysfunctional uterine bleeding dub is defined as abnormal uterine bleeding in the absence of organic disease. Dub is typically characterized by heavy prolonged flow with or without breakthrough bleeding. Hormonal treatments such as oral progestogen or the levonorgestrel releasing intrauterine system can be useful, particularly in dysfunctional uterine bleeding, and long term randomised controlled trials report a decrease in the number of bleeding days. Management of abnormal uterine bleeding in reproductive period evidencebased good clinical practice recommendations for indian women a gynae endocrine society of india gesi initiative in collaboration with endocrine. Discuss the differential diagnosis of abnormal vaginal bleeding in adolescents. What is dysfunctional uterine bleedingtypescausessymptoms. Dysfunctional uterine bleeding dub is defined as abnormal uterine bleeding in the absence of organic disease. Chronic heavy or prolonged uterine bleeding can result in anemia, interfere with daily activities, and raise concerns about uterine. Ppt abnormal uterine bleeding powerpoint presentation. Abnormal uterine bleeding due to ovulatory dysfunction aubo is abnormal uterine bleeding that, after examination and ultrasonography, cannot be attributed to the usual causes structural gynecologic abnormalities, cancer, inflammation, systemic disorders, pregnancy, complications of pregnancy, use of oral contraceptives or certain drugs.
How best to manage dysfunctional uterine bleeding mdedge. Management of women with bleeding irregulatories while sing. The patients perception of abnormal bleeding may be misleading and education about normality might be all that is necessary. Case histor yissn 24718165 introduction gynecology. Abnormal uterine bleeding guidelines bmj best practice. American college of obstetricians and gynecologists. Primary care management of abnormal uterine bleeding. Many terms have been used to describe nonorganic abnormal uterine bleeding, including dysfunctional uterine bleeding, menorrhagia, polymenorrhoea and metrorrhagia. Acute aub refers to an episode of heavy bleeding that, in the opinion of the clinician, is of sufficient quantity to require immediate intervention to prevent further blood loss 1. Management of dysfunctional uterine bleeding sciencedirect. Abnormal uterine bleeding aub is a significant clinical entity. This article provides nps with a practical overview of the process from chief complaint to followup care.
C initiate a workup for a coagulation disorder in women who are close to the onset of menarche and have a history of heavy menstrual bleeding. It is responsible for about half of the women with abnormal uterine bleeding in reproductive age ewenstein, 1996. Dysfunctional uterine bleeding is a diagnosis of exclusion. There is no hormonal defect in dysfunctional uterine bleeding, however, disturbances in endometrial mediators have been noted. It is a diagnosis of exclusion made after structural causes of bleeding and chronic medical diseases have been ruled out.
Abnormal vaginal bleeding in adolescents susan hayden. Abnormal uterine bleeding aub is defined as changes in frequency of menses, duration of flow or amount of blood loss. Discussion dysfunctional uterine bleeding is defined as heavy menstrual uterine bleeding not due to. Abnormal uterine bleeding aub may be acute or chronic and is defined as bleeding from the uterine corpus that is abnormal in regularity, volume, frequency, or duration and occurs in the absence of pregnancy 1 2. Management of acute abnormal uterine bleeding in nonpregnant. Bear in mind that abnormal uterine bleeding is a subjective complaint, and a detailed history is the key initial step in management. Abnormal uterine bleeding related to ovulatory dysfunction i. Laboratory and radiologic studies pertinent to the evaluation of dysfunctional uterine bleeding are delineated. Because of this complexity, concise guidelines have been difficult to develop. This includes procedures that use a resectoscope to surgically remove, electrically desiccate or vaporize the endometrium, as well as laser destruction of the. Dysfunctional uterine bleeding background dysfunctional uterine bleeding dub is the major cause of heavy menstrual bleeding and impacts on womens health both medically and socially. Dysfunctional uterine bleeding dub is a diagnosis of exclusion when there is no pelvic pathology or underlying medical cause.
Guidelines for the management of heavy menstrual bleeding explanation of grading of evidence the working party accepted a grading of evidence recommended by the department of health, uk and endorsed by the national health service executive, uk mann 1996. Abnormal uterine bleeding is one of the most common reasons for women to seek for care. Further management depends on patient preferences and effect of bleeding on. Although many etiologies cause aub, the one most likely cause among adolescents are dysfunctional uterine bleeding dub. Evaluation and management of abnormal uterine bleeding in premenopausal women. Abnormal uterine bleeding is a common problem,1 and its management can be complex. Evaluation and management of adolescents with abnormal. Dysfunctional uterine bleeding is the occurrence of uterine bleeding unrelated to structural abnormalities of the uterus or the endometrial lining. Cer 96 primary care management of abnormal uterine bleeding. A common and often debilitating condition, affecting women of reproductive age. It reflects an interruption in the normal cyclic pattern of ovulatory hormonal stimulation to the endometrial lining. Perform endometrial biopsy on all women who have abnormal uterine bleeding and risk factors for endometrial cancer and on all women. Guidelines for the management of abnormal uterine bleeding. Management of abnormal uterine bleeding in reproductive period.
It may impact physical, emotional sexual and professional aspects of the lives of women, impairing their quality of life. Management of abnormal uterine bleeding in reproductive. It is a difficult condition for the woman, mentally as well as socially and also financially. Pdf dysfunctional uterine bleeding and its management. History should focus on the type of abnormal bleeding.
Know the types, causes, symptoms, treatment and diagnosis of dysfunctional uterine bleeding. Dysfunctional uterine bleeding and its management strategy article pdf available in jnma. Abnormal uterine bleeding british medical bulletin. Management of abnormal uterine bleeding in reproductive period evidencebased good clinical practice recommendations for indian women a gynae endocrine society of india gesi initiative in collaboration with endocrine committee of association of obstetricians and gynaecologists of delhi. The most common reason for a divergence from a pattern of regular menses is pregnancy or a complication of pregnancy, such as ectopic pregnancy or threatened or incomplete abortion. However, heavy menstrual bleeding is now the preferred term over these historic descriptions. Approach to diagnosis and management of abnormal uterine bleeding. The international federation of gynecology and obstetrics and the american congress of. Abnormal uterine bleeding aub is any variance of the normal menstrual cycle, which is defined on the basis of four parameters frequency, regularity, duration, and volume. May 29, 2018 dysfunctional uterine bleeding is basically abnormal vaginal bleeding in the reproductive years of a woman. Primary care management of abnormal uterine bleeding aub.
Management of dysfunctional uterine bleeding and infertility. Ovulatory dysfunctional uterine bleeding is the major pattern in 30s, whereas anovulatory dysfunctional uterine bleeding is more likely to occur at the extremes of reproductive years and in women who have polycystic ovarian syndrome. One national study found that menstrual disorders were the reason for 19. Cer 96 primary care management of abnormal uterine. Dysfunctional uterine bleeding describes the sp ectrum of abnormal bleeding patterns in the abscence of a medical illness or pelvic pathology. The condition occurs in approximately 1 in every 3 women of reproductive age and 1 in 10 postmenopausal women, and the impact on quality of life is often substantial. The management of dysfunctional uterine bleeding glowm. Dysfunctional uterine bleeding pdf 59kb pdf back issue. Clinical policy effective11012011 19962012, oxford health plans, llc 2 description of servicebackground information abnormal uterine bleeding in women of childbearing age is defined as any change in menstrual. Abnormal uterine bleeding is a common problem, and its management can be complex. Chronic abnormal uterine bleeding aub, a term that refers to menstrual bleeding of abnormal quantity, duration, or schedule, is a common gynecologic problem, occurring in approximately 10 to 35 percent of women. Michael evans developed the onepager concept to provide clinicians with useful clinical information on primary care topics. Further management depends on patient preferences and effect of bleeding on quality. Chronic heavy or prolonged uterine bleeding can result in anemia, interfere with daily activities, and raise concerns about.
Whats new in the management of heavy menstrual bleeding. The working group recommended abandoning the term dysfunctional uterine bleeding. Abnormal uterine bleeding aub is a frequent cause of visits to health care provider during adolescent period and is characterized by irregular, excessively heavy, prolonged andor frequent bleeding of uterine origin. A systematic approach to chronic abnormal uterine bleeding. Abnormal uterine bleeding treatment algorithm bmj best. Medical therapy is the principal tenet of treatment and is.
Jan 28, 2017 abnormal uterine bleeding previously, dysfunctional uterine bleeding dub is irregular uterine bleeding that happens in the absence of recognizable pelvic pathology, basic medical disease, or pregnancy. Abnormal vaginal bleeding in adolescents susan hayden gray, md. Hysterectomy is only required if profuse persistent uterine bleeding is not responsive to medical oestrogen therapy. Approach to diagnosis and management of abnormal uterine. Abnormal uterine bleeding murtaghs general practice, 7e. The diagnosis and treatment of dysfunctional uterine bleeding can be a long emotional journey for the patient and a difficult challenge for the provider. Dysfunctional uterine bleeding dub represents a particular type of abnormal uterine bleeding aub, and is defined in the usa as an excessive, prolonged and irregular bleeding of the endometrium. Abnormal uterine bleeding due to ovulatory dysfunction aubo. Abnormal uterine bleeding a free powerpoint ppt presentation displayed as a flash slide show on id. Dysfunctional uterine bleeding dub is more common at the extremes of the reproductive era see fig. Abnormal uterine bleeding occurs in 9 to 14 percent of women between menarche and menopause, significantly impacting quality of life and imposing financial burden. Chronic abnormal uterine bleeding aub, a term that refers to menstrual bleeding of abnormal quantity, duration, or schedule, is a common.
Management of abnormal uterine bleeding 3 treatment could be initiated in a primary care setting or in 1. Treatment of abnormal uterine bleeding depends on multiple factors, such as the. Dysfunctional uterine bleeding and uterine fibroids. The evaluation and management of any abnormal uterine bleeding is a complex process involving many decisions being made concurrently. Aub and its sub group, heavy menstrual bleeding hmb, are common conditions affecting 1425% of women of reproductive age, and may have a significant impact on their physical, social, emotional and material quality of life.
Acog releases guidelines on management of abnormal uterine. In the meantime the article is available for download below. The symptom of menorrhagia accounts for a significant proportion of referrals to gynaecologists. It usually presents as heavy menstrual bleeding menorrhagia.
Abnormal uterine bleeding is fairly common among women presenting to their family doctors and is the most common reason for referral to gynecologists. Dysfunctional uterine bleeding has a wide spectrum of presentations that. Overview of abnormal uterine bleeding in adolescents. This is a typical case of dysfunctional uterine bleeding. Guidance for management of troublesome vaginal bleeding. Dysfunctional uterine bleeding is one of the most common reasons patients seek the opinion of a gynecologist. Management of women with bleeding irregulatories while. Adenomyosis, which is associated with abnormal uterine bleeding, pelvic pain. We constructed a concise but comprehensive algorithm for the management of abnormal uterine bleeding between menarche and menopause. The diagnosis of dub can only be made once all other causes of abnormal or heavy uterine bleeding have been excluded. Most cases, however, can be managed by family doctors. Abnormal uterine bleeding dysfunctional uterine bleeding ncbi.
Jan 01, 2012 abnormal uterine bleeding occurs in 9 to 14 percent of women between menarche and menopause, significantly impacting quality of life and imposing financial burden. The guideline advisory committee gac database, the canadian medical association infobase for guidelines, and clinical evidence were also searched. Abnormal uterine bleeding aub is a common but complicated clinical presentation. The recommendations in this guideline represent the view of nice, arrived at after careful. This guideline provides recommendations to gynaecologists and other health care providers in the diagnosis and management of abnormal uterine bleeding, incorporating the current evidence. Other causes of abnormal bleeding must also be ruled out, including. Medical management of dysfunctional uterine bleeding. Evaluation and management of abnormal uterine bleeding in.
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