management of abnormal uterine bleeding
Last edited 09/2018
Management of abnormal uterine bleeding depends on 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 hormaonal
- 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 anemia
- 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:
management of heavy menstrual bleeding
management of PALM-COEIN causes of abnormal uterine bleeding