Abnormal Uterine Bleeding

Abstract

Abnormal uterine bleeding is a frequent condition in Gynecology. It may impact physical, emotional sexual and professional aspects of the lives of women, impairing their quality of life. In cases of acute and severe bleeding, women may need urgent treatment with volumetric replacement and prescription of hemostatic substances. In some specific cases with more intense and prolonged bleeding, surgical treatment may be necessary. The objective of this chapter is to describe the main evidence on the treatment of women with abnormal uterine bleeding, both acute and chronic. Didactically, the treatment options were based on the current International Federation of Gynecology and Obstetrics (FIGO) classification system (PALM-COEIN). The etiologies of PALM-COEIN are: uterine Polyp (P), Adenomyosis (A), Leiomyoma (L), precursor and Malignant lesions of the uterine body (M), Coagulopathies (C), Ovulatory dysfunction (O), Endometrial dysfunction (E), Iatrogenic (I), and Not yet classified (N). The articles were selected according to the recommendation grades of the PubMed, Cochrane and Embase databases, and those in which the main objective was the reduction of uterine menstrual bleeding were included. Only studies written in English were included. All editorial or complete papers that were not consistent with abnormal uterine bleeding, or studies in animal models, were excluded. The main objective of the treatment is the reduction of menstrual flow and morbidity and the improvement of quality of life. It is important to emphasize that the treatment in the acute phase aims to hemodynamically stabilize the patient and stop excessive bleeding, while the treatment in the chronic phase is based on correcting menstrual dysfunction according to its etiology and clinical manifestations. The treatment may be surgical or pharmacological, and the latter is based mainly on hormonal therapy, anti-inflammatory drugs and antifibrinolytics.

Relationship between endometrial thickness and neutrophil/lymphocyte ratio with endometrial malignancy in 386 postmenopausal uterine bleeding cases

“…Abnormal uterine bleeding appears to be one of the most common gynecological problems affecting women's quality of life, especially in the postmenopausal period [1]. The diagnostic approach to women with abnormal bleeding has evolved over the years, from dilatation and curettage (D + C) in operating room conditions, to vacuum-aspiration curettage and Pipelle plastic catheter curettage in outpatient clinics [3,5].…”

“…Abnormal uterine bleeding appears to be one of the most common gynecological problems affecting the quality of life of women [1]. The approach to this clinical problem that arises as a result of structural or functional pathologies of the endometrium varies according to whether the patient is in the pre-, peri-, or postmenopausal period [2,3].…”

Seguridad y aceptabilidad del sistema intrauterino liberador de levonorgestrel 52 mg en mujeres con hemorragia uterina anormal en un centro de atención ambulatoria en Bogotá, Colombia, 2012-2016

“…Se ha descrito que es útil en el manejo de síntomas como: dismenorrea, dolor asociado a endometriosis, anemia, hiperplasia endometrial y terapia de reemplazo de estrógeno (7,16). El SIU-LNG es eficaz en el control de la pérdida sanguínea medida como diferencia media 66,91 mL (intervalo de confianza [IC] 95 %: 42,61-91,2) y mejorar la calidad de vida (diferencia media = 2,90; IC 95 %: 0,06-5,74) (17), por tanto, ha sido sugerido como tratamiento de elección en pacientes con sangrado menstrual abundante y útero sin alteraciones estructurales (18,19), o en pacientes con miomatosis uterina menor de 3 cm (7). También es útil para el manejo de mujeres con hiperplasia endometrial (20).…”

Custo-efetividade e limiar de custo para o uso do sistema intrauterino liberador de levonorgestrel para o tratamento do sangramento uterino anormal sob a perspectiva do Sistema de Saúde Suplementar no Brasil

“…Essa alteração pode se apresentar por aumento no volume, na duração ou na frequência do ciclo menstrual. A condição pode estar relacionada a causas estruturais, tais como pólipos, adenomiose, leiomioma ou malignidade e hiperplasia, ou ainda a causas não estruturais como coagulopatias, distúrbios da ovulação, disfunção endometrial ou por iatrogenia ou sem causa identificada (Benetti-Pinto et al, 2017;Walker et al, 2020).…”

“…Já no Brasil, um estudo conduzido na cidade de Pelotas estimou que 46,4% das mulheres entrevistadas, na faixa etária entre 15 e 54 anos, apresentavam pelo menos um distúrbio menstrual, sendo o sangramento menstrual excessivo o mais prevalente (23,2%) ( Barcelos et al, 2013). Sua ocorrência está relacionada a um impacto importante, reduzindo a qualidade de vida de maneira significativa de acordo com o aumento do volume do sangramento e aumentando a ocorrência de condições como anemia, necessidade de realização de procedimentos cirúrgicos, dor/dismenorreia, absenteísmo, entre outras (Benetti-Pinto et al, 2017;Jensen et al, 2012). Há também um impacto imposto para a sociedade em geral, por meio de uma maior utilização de recursos e custos.…”