Management of abnormal uterine bleeding

Management of abnormal uterine bleeding depends on the cause.

Medical treatment

• is considered as the first line therapeutic option for AUB (once malignancy and significant pelvic pathology have been ruled out).
• underlying medical condition should be addressed first before initiating any medical agents e.g. – treatment of hypothyroidism
• iron supplementation should be started immediately in patients who are anaemic
• treatment should be tailored to
  • the individual woman’s therapeutic goals
  • desire for contraception
  • underlying medical conditions
  • tolerance of side effects
• effective medical treatment options include:
  • non hormonal
    • NSAIDs
    • antifibrinolytics
  • hormonal
    • combined hormonal contraceptives
    • levonorgestrel-releasing intrauterine system
    • oral progestins
    • depot-medroxyprogesterone acetate
    • danazol
    • GnRH agonist (1)

Surgical management

• indications for surgery for women with AUB include
  • failure to respond to medical therapy
  • inability to utilize medical therapies (i.e. side effects, contraindications)
  • significant anaemia
  • impact on quality of life
  • concomitant uterine pathology (large uterine fibroids, endometrial hyperplasia).
• surgical options include
  • dilation and uterine curettage
  • hysteroscopic polypectomy
  • endometrial ablation
  • myomectomy
  • hysterectomy (1)

Reference:

1. American College of Obstetricians and Gynecologists. ACOG committee opinion no. 557: management of acute abnormal uterine bleeding in nonpregnant reproductive-aged women. Apr 2013 [internet publication].