Abnormal uterine bleeding: managing endometrial dysfunction and leiomyomas

Abstract

Abnormal uterine bleeding refers to any change in the regularity, frequency, heaviness or length of menstruation. There are several potential causes for bleeding disturbance, the two most common being primary endometrial dysfunction and fibroids. Management of abnormal uterine bleeding involves both medical and surgical options and will largely depend on a patient's fertility plans. The use of levonorgestrel-releasing intrauterine devices for heavy menstrual bleeding is increasing in Australia, and they are considered first-line medical management for women accepting of hormonal therapies. Tranexamic acid, non-steroidal anti-inflammatory drugs, the combined oral contraceptive pill and oral progestins offer alternatives. Hysterectomy offers a definitive surgical approach to abnormal uterine bleeding and is associated with high levels of patient satisfaction. Women wishing to preserve their fertility, or avoid hysterectomy, may be offered myomectomy. Submucosal fibroids should be removed via hysteroscopy in symptomatic or infertile patients. Intramural and subserosal fibroids may be removed via an open or laparoscopic approach. There are several minimally invasive options, including uterine artery embolisation, magnetic resonance-guided focused ultrasound and endometrial ablation, but patients should be aware that there is insufficient evidence to ensure fertility preservation with these procedures and further research is needed. Areas for additional research include cost-effectiveness of treatments and quality of life comparisons between management options using patient reported outcome measures to evaluate patient satisfaction.

Treatment of symptomatic fibroid disease using uterine fibroid embolisation: An Australian perspective

“…Hysterectomy is the most definitive treatment for women with refractory disease, particularly when child‐bearing is no longer a consideration . It is estimated that 20% of hysterectomies in Australia are performed for fibroid disease .…”

“…6,8 Hysterectomy is the most definitive treatment for women with refractory disease, particularly when child-bearing is no longer a consideration. 3,9 It is estimated that 20% of hysterectomies in Australia are performed for fibroid disease. 10 In addition to being widely accessible and effective, it also has advantages in allowing histologic evaluation of uterine tissue to exclude malignancy.…”

“…Uterine leiomyomata cause morbidity to Australian women, with an estimated prevalence of up to 75% in society and up to 35% of women may be symptomatic . Symptoms include heavy menstrual bleeding, dysmenorrhoea, and/or pressure symptoms to surrounding organs . In 2015, Soliman estimated the cost‐burden of disease by systematically reviewing 26 studies and considering the total direct costs as well as indirect costs (including loss of wages), estimating a cost to society of between USD$2200 and USD$15 952 per person per year …”

“…1,2 Symptoms include heavy menstrual bleeding, dysmenorrhoea, and/or pressure symptoms to surrounding organs. 3 In 2015, Soliman estimated the cost-burden of disease by systematically reviewing 26 studies and considering the total direct costs as well as indirect costs (including loss of wages), estimating a cost to society of between USD$2200 and USD$15 952 per person per year. 4 Patients who are asymptomatic require no treatment.…”

Diagnostic Value of Vaginal Ultrasound under Improved Clustering Algorithm Combined with Hysteroscopy in Abnormal Uterine Bleeding

“…The early stage of endometrial cancer is limited to the endometrial mucosal layer or superficial base layer, but the site of occurrence is often found in the uterine horn, and the traditional curettage is easy to miss curettage, thus missing the diagnosis of endometrial cancer [ 12 ]. If hysteroscopy is adopted, the situation of the entire endometrial can be determined, so hysteroscopy can reduce the occurrence of curettage and leakage in traditional diagnosis and improve the accuracy of endometrial cancer diagnosis [ 13 ].…”