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:

• (1) Singh S et al. Abnormal uterine bleeding in pre-menopausal women. J Obstet Gynaecol Can. 2013;35(5):473-475.