Levonorgestrel-IUD should be offered before hysterectomy for abnormal uterine bleeding without uterine structural abnormalities: there are no more excuses!

Background: Perimenopause is described as years prior to menopause that encompasses the change from normal ovulatory cycle to cessation of menses, ending 12 months after the last menses. International federation of gynaecology and obstetrics (FIGO) developed a new classification PALM-COEIN in order to standardize the factors associated with AUB. It classifies AUB as polyp, adenomyosis, leiomyoma, malignancy and hyperplasia (PALM) - structural abnormalities Coagulopathy, ovulatory dysfunction, endometrial, iatrogenic, not yet classified (COEIN) - unrelated to structural abnormalities. Objectives of this study were to categorise the causes of AUB in perimenopausal women in context to PALM COEIN classification system. Correlation of co-morbities (diabetes, hypertension and thyroid disorders) with AUB in perimenopausal age group.Methods: This is a retrospective study from the month of May 2019 to October 2019, considering 100 patients of perimenopausal age group (40 to 55 years of age group) in J. K. Hospital Bhopal, Madhya Pradesh with complaints of abnormal uterine bleeding, admitted in gynae ward.Results: Most of the patients in the current study were between 45-50 years of age i.e. 44%. Menorrhagia was the commonest menstrual disorder encountered in 52% of patients. As per FIGO; AUB-L constituted 42% AUB-O constituted 12%, AUB-P constituted 11%, AUB-A 10%, AUB-M constituted 8% AUB-E constituted 8%, not yet classified constituted 4% of total cases.Conclusions: AUB (PALM-COEIN) for causes of abnormal uterine bleeding classification was very useful in categorizing cases of AUB. It suggests that etiology of AUB and also gives place for presence of multiple factors as a cause of AUB in a particular case.

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Therapeutic tactics in abnormal uterine bleeding without anatomical substrate

Medical Council ◽

10.21518/2079-701x-2018-21-168-172 ◽

2019 ◽

pp. 168-172

Author(s):

G. В. Dikke

Keyword(s):

Blood Loss ◽

Abnormal Uterine Bleeding ◽

Similar Efficacy ◽

Uterine Bleeding ◽

Reduce Blood Loss ◽

Intrauterine Devices ◽

Menstrual Blood Loss ◽

First Line ◽

Structural Abnormalities ◽

Proven Efficacy

The purpose of the review:presentation of modern data on the pathogenesis of abnormal uterine bleeding (AMC) without anatomical substrate (ovulatory, endometrial, coagulopathic) and the effectiveness of their treatment with medication.Basic provisions.Information on the pathogenesis of AMC not associated with structural abnormalities of the uterus is presented. It was shown that non-hormonal drugs have similar efficacy. Among the hormonal agents, levonorgestrel-containing intrauterine system (IUD-LNG) and estrogen-progestogen preparations (combined oral contraceptives, COCs) favorably differ. COCs recover an acute episode of AMC in 66.8% of cases (according to some data – in 88%), which is higher in comparison with non-hormonal drugs; in chronic cases – reduce blood loss by 88% (after 6 months of therapy), and are not inferior in effectiveness to intrauterine devices with levonorgestrel (83% after 3 months of therapy).The conclusion.Thus, non-hormonal drugs have similar efficacy in arresting AMC without an anatomical substrate, but are inferior to COCs. In case of chronic AMC, the first-line drugs are IUD-LNG and COC containing E2B / NNG, which contribute to the normalization of the menstrual cycle and the volume of menstrual blood loss with proven efficacy.

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GAMBARAN KLINIS DAN HISTOPATOLOGI KASUS-KASUS ABNORMAL UTERINE BLEEDING DI RUMAH SAKIT SUMBER WARAS

Jurnal Bakti Masyarakat Indonesia ◽

10.24912/jbmi.v3i1.8038 ◽

2020 ◽

Vol 3 (1) ◽

Author(s):

Andriana Kumala Dewi ◽

Sony Sugiharto ◽

Anthony Paulo Sunjaya ◽

Angela Felicia Sunjaya

Keyword(s):

Ovarian Function ◽

Abnormal Uterine Bleeding ◽

Operative Management ◽

Uterine Bleeding ◽

Cross Sectional ◽

Structural Abnormalities ◽

Abnormal Bleeding ◽

Over 40 Years ◽

Anatomical Pathology ◽

Average Hemoglobin

Abnormal Bleeding Uterine Problems (AUB) is the most common disorder found in daily gynecological practice. AUB can occur at any age between menarche and menopause, but this disorder is more often found during the beginning and the end of ovarian function. Two-thirds of women who are hospitalized with abnormal uterine bleeding are over 40 years old. The causes of AUB are broadly divided into 2 namely structural and non-structural abnormalities. Diagnosis and management of abnormal uterine bleeding is currently a challenge in the field of gynecology because complaints of vaginal bleeding are the most common complaints that bring patients to health facilities. This study aims to find any histopathological features that are often found in patients with a diagnosis of AUB. This research method is a cross-sectional retrospective. Obtained 87 patients diagnosed with abnormal AUB who performed operative management during the period January to December 2018 from the Sumber Waras Hospital Polyclinic. The results of laboratory tests before the treatment showed that the majority of patients (59.8%) had anemia with an average hemoglobin of 10.79 (± 2.40) mg / dL. In the majority of patients with AUB (66.9%) the procedure was performed in the form of a biopsy/curette of the endometrial tissue for anatomical pathology. Meanwhile, based on the results obtained by the histopathological picture, found in the majority of patients found a picture of structural pathology (PALM) that is 86.2%ABSTRAK:Masalah Abnormal Uterine Bleeding (AUB) merupakan kelainan yang paling sering ditemukan dalam praktik ginekologi sehari-hari. AUB dapat terjadi pada setiap umur antara menarche dan menopause, tetapi kelainan ini lebih sering dijumpai sewaktu masa permulaan dan masa akhir fungsi ovarium. Dua pertiga dari perempuan yang dirawat di rumah sakit dengan keluhan perdarahan uterus abnormal berumur diatas 40 tahun. Penyebab AUB secara garis besar dibagi menjadi 2 yaitu kelainan struktural dan non struktural. Diagnosis dan manajemen dari perdarahan uterus abnormal saat ini menjadi suatu tantangan dalam bidang ginekologi karena keluhan perdarahan per vaginal adalah keluhan tersering yang membawa pasien datan ke fasilitas kesehatan. Penelitian ini bertujuan untuk menemukan gambaran histopatologis apa saja yang sering ditemukan pada pasien dengan diagnosis AUB. Metode penelitian ini adalah cross sectional retrospective. Diperoleh 87 pasien yang didiagnosis menderita abnormal AUB yang dilakukan tatalaksana secara operatif selama periode Januari sampai Desember 2018 dari Poliklinik RS Sumber Waras. Hasil pemeriksaan laboratorium sebelum tindakan menunjukkan bahwa mayoritas pasien (59.8%) menderita anemia dengan rerata hemoglobin 10.79 (±2.40) mg/dL Pada sebagian besar pasien dengan AUB (66.9%) tindakan yang dilakukan berupa biopsi/kuret jaringan endometrium untuk pemeriksaan patologi anatomi. Sedangkan, berdasar hasil gambaran histopatologis yang didapat, ditemukan pada mayoritas pasien ditemukan gambaran patologi struktural (PALM) yaitu 86,2%.

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