Uterine bleeding: how understanding endometrial physiology underpins menstrual health

Abstract

Menstrual healthA state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity, in relation to the menstrual cycle.

Investigating abnormal uterine bleeding in reproductive aged women

“…Offer examination before investigation, including a general physical examination to look for signs of systemic disease such as anaemia, thyroid disease, or polycystic ovary syndrome (signs might include, for example, acne or hirsutism); an abdominal exam for a bulky uterus or abdominal mass; and a speculum and pelvic examination in women to whom this is acceptable 117. An intimate pelvic examination may not be acceptable, for example, to women who have never been sexually active, adolescents, or those who are unable to tolerate such examination 13. If a cervical ectropion is seen on examination, continue further investigation to exclude other causes of intermenstrual bleeding, because an ectropion may coexist with other causes of AUB.…”

“…Pelvic ultrasound is the first line imaging investigation, ideally transvaginal, but this may not be appropriate in all women, especially adolescents and those who have never been sexually active 1417. MRI is not routinely offered as a first-line diagnostic tool13; endometrial thickness in women of reproductive age is of limited value in detecting abnormalities, as it changes throughout the menstrual cycle 17…”

“…Pelvic ultrasound is not 100% sensitive 13. For women with risk factors for endometrial hyperplasia or malignancy (box 1), unexplained or persistent AUB, or for whom treatment has failed but who have a normal pelvic ultrasound scan, offer referral for endometrial sampling 217.…”

Safety and efficacy of Ninjin’yoeito along with iron supplementation therapy for preoperative anemia, fatigue, and anxiety in patients with gynecological disease: an open-label, single-center, randomized phase-II trial

“…World Health Organization estimates that one-third of all women of reproductive age are anemic [ 1 ], and women of reproductive age are most likely to be affected by iron deficiency, which is responsible for approximately 51% of global cases of anemia [ 2 ]. In 18 large observational studies encompassing over 650,000 surgical patients, the mean prevalence of pre-operative anemia was around 35%, varying between 10.5% and 47.9% [ 3 ].…”

“…In a study by Richards T, et al, among 12,836 patients undergoing gynecological surgery, the prevalence of preoperative anemia was 23.9% (95% CI 23.2–24.7) [ 4 ]. Representative gynecological diseases such as polyp, adenomyosis, uterine fibroids and malignancies often cause abnormal uterine bleeding (AUB), and on average, 30% of women globally with AUB are anemic [ 2 ]. Furthermore, preoperative anemia can affect surgical outcomes and may contribute to postoperative complications such as cardiac disease, respiratory disease, systemic sepsis, venous thrombosis, and major bleeding [ 4 ].…”