Abnormal Uterine Bleeding in Perimenopausal Women: The Role of Hysteroscopy and Its Impact on Quality of Life and Sexuality

Abstract

Abnormal uterine bleeding (AUB) is a frequent symptom in perimenopausal women. It is defined as uterine bleeding in which the duration, frequency, or amount of bleeding is considered excessive and negatively affects the woman’s quality of life (QoL) and psychological well-being. In cases of structural uterine pathology, hysterectomy (usually performed via a minimally invasive approach) offers definitive symptom relief and is associated with long-lasting improvement of QoL and sexuality. However, over the past 30 years, uterus-preserving treatments have been introduced as alternatives to hysterectomy. Hysteroscopic polypectomy, myomectomy, or endometrial resection/endometrial ablation are minimally invasive techniques that can be used as an alternative to hysterectomy to treat AUB due to benign conditions. Although associated with high patient satisfaction and short-term improvement in their QoL, hysteroscopic treatments do not eliminate the risk of AUB recurrence or the need for further intervention. Therefore, considering the impact of different treatment options on QoL and sexuality during preoperative shared decision making could help identify the most appropriate and personalized treatment options for perimenopausal women suffering from AUB.

Comparison of Two-Dimensional Transvaginal Ultrasound, Three-Dimensional Transvaginal Ultrasound and Hysteroscopy to Diagnose in Patients With Abnormal Uterine Bleeding: A Retrospective Observational Study

“…22,28,37 Hysteroscopy is an important method for the diagnosis of an intrauterine pathology with AUB and taking a targeted biopsy. 38 The sensitivity and specificity are high in a large series of hysteroscopies performed in postmenopausal patients (98.2%). 39 However, it provides subjective evaluation and indirect information regarding the depth of myometrial extension.…”

Molaterhesség postmenopausában

“…Tünetei alapján spontán vetéléssel, méhen kívüli terhességgel vagy egyéb eredetű postmenopausalis vérzési rendellenességekkel téveszthető össze, amit jól mutat, hogy egy korábbi tanulmányban a teljes molával intézetbe került betegek 91%-ában korábban inkomplett abortusz miatt történt ellátás [5]. Postmenopausalis nőbeteg esetén a vérzési rendellenesség hátterében a leggyakrabban méhnyálkahártya-eltérés (polypus, hyperplasia), myoma vagy anovulációs vérzészavar (progeszteronhiány) áll; különlegesen ritka a terhességi trophoblastbetegség, amelyre érdemes gondolni, mivel az előbbiekhez hasonló panaszokat okoz [6].…”

Operative Hysteroscopy Versus Levonorgestrel-Releasing Intrauterine System (LNG-IUS) Insertion: A Prospective Observational Study on the Effect of Surgical and Medical Treatments on Sexual Functions in Women With Abnormal Uterine Bleeding

“…Studies have shown that women with AUB may experience various sexual difficulties, including decreased sexual desire, pain during intercourse, and reduced sexual satisfaction. This may be due to various factors, including physical discomfort and anxiety related to bleeding, hormonal imbalances, and psychological distress [ 4 ].…”

“…AUB is the most common indication to perform hysteroscopy in perimenopausal women. The hysteroscopic “see-and-treat” method enables examination of the uterine cavity, targeted biopsies of the endometrial areas, and immediate treatment of endometrial or submucosal pathologies (such as polyps and myomas) if necessary [ 4 ]. Minimally invasive operative hysteroscopy treatments have been shown to be effective in treating AUB, improving quality of life, and possibly avoiding or delaying hysterectomy.…”